COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDAHD 


HX64073955 
RA448  F64  Health  conditions  an 


RECAP 


HEALTH  CONDITIONS 

AND 

HEALTH  SERVICE 

IN 

SAINT   PAUL 


ESTHER  JlRlNT 

WITH     THB     CO- OPS  RAT  I  OK    OT 

CA^OL  MpNOYlCl 


Columbia  Untomitp 

intljeCttpirfltegork 

College  of  $fjpsician£  anb  burgeon* 

Htbrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/healthconditionsOOflin 


HEALTH  CONDITIONS 

AND 

HEALTH  SERVICE 

IN 

SAINT   PAUL 


Esther  It  Hint 

WITH     THE     CO-OPERATION    OT 

CA^OL  AJRONOVICI 


Table  of  Contents 


Page  No. 

Introduction     3 

Acknowledgment     4 

General   Considerations    5 

Location    5 

Population    5 

Vital   Statistics    9 

General  Death  Rate   9 

Infant   Mortality    10 

Main  Causes  of  Death 11 

Statistical  Data  for  Specific  Diseases 16 

Sanitation    , 29 

Housing    29 

City   Water    Supply    30 

Sewerage 32 

Garbage  and  Refuse  Disposal   33 

Health    Agencies    35 

Public   Health  Agencies    35 

Relation  of  Health  Bureau  to  General  City  Government  35 

Organization  of  Bureau    40 

Food   and    Meat    Inspection    45 

The  Milk  Supply  and  Dairy  Inspection  48 

Sanitary  Inspection  -of  Hotels  and  Restaurants   51 

The  Control  of  Communicable  Diseases   53 

The  Control  of  Tuberculosis    56 

Infant   Welfare   Work    61 

The  Recording  of  Vital  Statistics    62 

Medical  Work  of  the  City  and  County  Board  of  Control  64 

Venereal    Diseases 65 

Mental    Hygiene 66 

Educational    Work    66 

Health    Budget    67 

Sanitary   Supervision   of    Schools    69 

Private   Health  Agencies 82 

Hospital    Facilities ' -. 82 

Charitable  and  Welfare  Agencies   Devoting   Part  or   Whole   Time  to 

Health   Work    83 

Health  Work  of  Professional  and  Commercial  Organizations   94 

Conditions  of  Health  in  Industry   95 

Conclusions    102 

(2) 


Introduction 

□ 

IN    consequence  of  the  rather  serious  conditions 
of  insanitation  revealed  by  the  Housing  Sur- 
vey which  pointed  to  certain  defects  in  sanitary 
legislation,    and   a   lack   of   adequate   and   efficient 
municipal  machinery  for  the  enforcement  of  exist- 
ing laws  this  study  was  undertaken. 

While  this  study  does  not  claim  to  present  all  the 
facts  relating  to  the  provision  for  the  protection, 
preservation  and  restoration  of  health,  the  facts  as 
stated  are  sufficiently  comprehensive  to  give  the  citi- 
zens of  St.  Paul  an  understanding  of  the  extent, 
character  and  adequacy  of  the  health  service  avail- 
able in  the  community. 

It  is  hoped  that  the  suggestions  and  criticisms 
offered  will  be  made  the  subject  of  free  discussion 
among  the  people  of  this  city  and  that  prompt  and 
constructive  action  will  result.  In  publishing  these 
facts  it  is  not  the  intention  of  the  Wilder  Charity  to 
criticise  personalities  or  agencies.  It  is  merely  an 
honest  effort  to  afford  an  opportunity  for  concerted 
action  that  would  lead  toward  keeping  the  health  rec- 
ord of  St.  Paul  at  the  head  of  the  list  of  healthy 
communities  throughout  the  United  States. 

Carol  Aronovici. 


(3) 


Acknowledgment 

□ 

In  gathering  the  data  the  writer  received  invalu- 
able co-operation  and  assistance  from  the  various 
agencies  whose  work  is  referred  to  in  this  study  and 
especially  from  the  Bureau  of  Health.  Miss  Ger- 
trude Armstrong,  a  member  of  the  staff  of  the 
Wilder  Charity  zuas  most  helpful  as  field  inves- 
tigator and  in  handling  the  statistical  data  contained 

in  this  report. 

Esther  M.  Flint. 


(4) 


General  Considerations 


Location 

Topography  and  Climate 

The  topographical  and  climatic  factors  of  the  City  of  St.  Paul  are 
admirable  from  the  point  of  view  of  health.  The  city  is  located  on  both 
banks  of  the  Mississippi  River,  altho  the  portion  on  the  southern  bank, 
known  as  the  West  Side,  or  more  recently  called  Riverview,  is  compara- 
tively small  and  isolated,  tending  to  form  a  more  or  less  separate  com- 
munity in  spite  of  the  three  bridges  connecting  it  with  the  main  portion 
of  the  city.  The  main  portion  lies  on  the  north  side  on  the  high  rolling 
land  which  ends  in  the  steep  bluffs  forming  the  banks  of  the  Mississippi, 
and  which  not  only  is  high  itself,  but  consists  also  of  various  hills  and 
ridges  so  that  the  site  is  one  affording  natural  drainage. 

The  climate  of  St.  Paul,  while  habitually  going  to  wide  seasonal  ex- 
tremes, is  not  normally  characterized  by  a  preponderance  of  either  in- 
tense heat  or  remarkably  severe  cold.  In  the  five  years  from  1913  to 
1917  the  average  maximum  temperature  was  95°,  the  average  minimum 
25°,  and  the  mean  43.7°.  But  in  that  time  the  average  number  of  days 
per  year  in  which  the  temperature  rose  to  90°  or  above  was  8,  and 
the  average  number  of  days  per  year  of  zero  weather  or  lower  was  34. 
The  precipitation  during  this  five  year  period  averaged  25.78  inches,  but 
that  was  due  to  special  conditions,  the  normal  precipitation  being  28.68 
inches.  The  average  snow  fall  was  43  inches.  The  prevailing  direction 
of  wind  is  northwest  in  the  season  from  November  to  April  and  south- 
east from  May  to  October.  The  percentage  of  hours  of  sunshine  to 
possible  hours  of  sunshine  is  about  55,  and  in  the  five  year  period  from 
1913  to  1917  there  averaged  120  clear  days,  131  partly  cloudy,  and  114 
cloudy  days.  The  mean  relative  humidity  in  this  period  averaged  about 
73%,  which  is  higher  than  it  probably  would  be  if  readings  were  taken 
more  frequently  as  they  are  taken  for  temperature,  since  the  city  is  sub- 
ject to  early  morning  fogs. 

Population 

The  total  area  of  the  City  of  St.  Paul  is  35,480  acres.  Of  this  2,092 
acres  are  water,  1,094  are  in  parks,  562  in  boulevards  and  20  in  municipal 
forest,  so  that  when  these  figures  are  deducted  and  allowance  made  for 

(5) 


various  other  non-occupiable  areas,  the  total  occupiable  area  of  the  city 
is  something  over  31,000  acres.  The  City  is  divided  into  twelve  wards, 
very  unequal  as  to  size  and  as  unequal  in  population.  The  total  popula- 
tion as  given  in  the  last  annual  report  of  the  Commissioner  of  Public 
Works,  1917,  is  276,000  which  figure  was  computed  on  the  basis  of  the 
1917  City  Directory.*  That  the  distribution  of  the  276,000  is  decidedly 
uneven  is  shown  by  the  fact  that  the  population  per  acre  varies  from  2.8 
in  the  Second  Ward  to  46.2  in  the  Fourth.  Out  of  the  whole  twelve 
wards  there  are  eight  wards  with  less  than  1 5  persons  per  acre. 

That  the  scattering  distribution  of  population  tends  towards  produc- 
ing somewhat  rural  conditions  is  borne  out  by  the  fact  that  the  Dairy  In- 
spector of  the  City  Health  Department  has  record  of  94  dairy  herds  com- 
prising 1,643  cows  within  the  city  limits.  Such  a  condition  very  natur- 
ally has  a  direct  bearing  upon  the  health  of  the  city. 

Another  factor  affecting  the  conditions  of  health  is  the  distribution  by 
nationality  of  the  population  of  St.  Paul.  The  figures  in  the  following 
tables  were  taken  from  the  United  States  Census  of  1910,  the  most  recent 
statistics  available. 

Table  I. 

Showing  Distribution  of  Population  in  St.  Paul  According  to  Country 

of  Birth  in  ipio. 

I TOTAL \  / FOREIGN v  / NATIVE \ 

Foreign  country  in  which                                      %  of                         BORN  Both  parents  One  parent 

born,  or  if  native,  in  which                                    total                                           ~  foreign  born  foreign  born 

parents  were  born                                   No.        population             "°*                   '°  No.  %                No.                  % 

Austria    8,209  3.83  3,900  1.97  3,405  1.28  904  .58 

Belgium    123  .05  70  .03  21  .01  32  .01 

Canada-French    3,436  1.60  1,096  .52  1,208  .56  1,132  .52 

Canada-Other    7,567  3.48  3,302  1.21  1,408  .79  2,857  1.48 

Denmark     2,964  1.38  1,412  .66  1,193  .56  359  .16 

England    5,509  2.57  2,136  .99  1.553  .73  1,820  .85 

Finland    102  .04  73  .03  14  .006  15  .007 

France   773  .36  276  .13  244  .11  253  .12 

Germany   45,739  21.30  14,025  6.55  23.558  10.97  8,156  3.78 

Greece    162  .08  129  .06  17  .008  16  .007 

Holland  428  .19  194  .09  158  .07  76  .03 

Hungary   2,888  1.35  1,989  .93  785  .37  114  .05 

Ireland    16,871  7.86  4,184  1.95  8,798  4.09  3,889  1.82 

Italy    3,136  1.46  1.994  .93  1,050  .49  92  .04 

Norway    9,294  4.33  4.063  1.89  4,001  1.87  1,230  .57 

Roumania    339  .16  267  .12  68  .03  4  .002 

Russia    7,007  3.27  4,359  2.04  2,428  1.13  220  .10 

Scotland    1,732  .81  669  .32  528  .24  535  .25 

Sweden    24,640  11.50  11,335  5.25  11.379  5.37  1,926  .88 

Switzerland    1,326  .63  544  .26  473  .23  309  .14 

Turkey    324  .16  202  .09  116  .07  6  .003 

Wales    263  .13  73  .03  79  .04  111  .05 

All    Other    7.090  3.30  232  .11  6,747  3.13  111  .05 

All   Countries    149,922  69.84  56,524  26.33  69,231  32.25  24,167  11.26 

*The  estimated  population  for  1917  of  the  City  of  St.  Paul,  given  by  the  Bureau  of 
Census,  is  252,465. 


(6) 


Table  1-a 

Showing  Distribution  of  Population  in  St.  Paul  According  to  Nativity  in 

ipio 

Nativitv  No.  %  of  Total  Population 

U.  S. ". 64,822  30.16 

Foreign-born    56,524  26.33 

Native  with  both  parents  foreign-born 24,167  11.26 

Native  with  one  parent  foreign-born 69,231  32.25 

Total .214,744  100.00 

Table  II. 
Showing  Distribution  of  Population  in  St.  Paul  According  to  Age  in  ipio 

Age  Period  Total  Native  White        Foreignborn  White    Negro  Indian 

Under    5    years 18,426  17,932  326  164  1 

Under    1    year    3,808  3,762  16  29  1 

5   to  9   years 17,485  16,416  928  140  1 

10  to  14  years   17,599  16,441  1,009  149  0 

15   to    19  years 22,125  20,025  1,915  177  0 

20  to  24  years 28,022  22,325  5,347  332  5 

25  to  34  years   44,530  29,933  13,581  997  1 

35   to   44  years 29,212  16,622  11,886  684  2 

45   to   64   years 30,900  13,490  16,966  430  0 

65  years  and  over 6,316  1,707  4,529  70  0 

Age   unknown    129  91  37  1  0 

Total   214,744  154,992  56,524  3,144  10 

It  is  of  considerable  interest  to  note  from  Table  1  that  practically 
70%  of  the  total  population  is  either  foreign-born,  or  native  with  wholly 
or  partly  foreign  parentage,  the  distribution  of  the  total  per  cent.  69.84 
being  26.33  foreign-born,  32.25  native  with  both  parents  foreign-born, 
and  11.26  native  with  one  parent  foreign-born.  Of  all  those  who  are 
foreign-born  or  have  foreign  parentage  the  German  and  Swedish  nation- 
alities are  far  in  the  lead,  being  21.3%  and  11.5%  respectively  of  the 
total  population  of  St.  Paul.  The  Irish,  Norwegians  and  Austrians  are 
next  in  importance,  altho  their  proportion  is  not  nearly  so  large,  7.86%, 
4.33%  and  3.83%  respectively  of  the  total  population.  About  the  same 
ratios  hold  true  for  the  above  nationalities  when  separated  into  the 
groups  of  foreign-born  and  native  with  one  or  both  parents  foreign-born, 
altho  in  the  case  of  the  Germans  and  the  Irish  the  American-born  with 
both  parents  foreign-born  have  a  decided  predominance — 10.97%  of  the 
total  population,  and  4.09%  for  the  Irish,  in  each  case  about  half  the  per 
cent,  for  the  total  number  of  persons  either  born  in  Germany  or  Ireland 
or  with  German  or  Irish  parentage. 

In  Table  I-a  is  shown  the  relation  between  American-born  inhabi- 
tants of  St.  Paul  and  the  foreign-born  or  those  who  have  one  or  both 
parents  foreign-born.  This  table,  however,  should  be  studied  in  con- 
junction with  Table  II.  It  is  interesting  to  note  that  while  the  natives 
of  native  parentage  (30.16%)  outnumber  the  foreign-born  (26.33%), 
yet  the  former  are  themselves  outnumbered  by  natives  with  one  foreign- 
born  parent  (32.25%)  to  the  extent  of  2.09%. 

(7) 


The  distribution  of  ages  among  the  native-born  and  foreign-born  as 
shown  in  Table  II  throws  some  light  on  the  trend  of  populational  distri- 
bution according  to  nativity  in  this  city.  It  is  evident  that  since  the  num- 
ber of  foreign-born  of  sixty-five  years  or  over  outnumber  those  under 
five  years  in  almost  the  same  proportion  that  the  native-born  under  five 
years  outnumber  the  native-born  of  sixty-five  or  over,  the  preponderance 
of  foreign-born  of  former  years  is  not  being  replaced  by  anywhere  near- 
ly the  same  number  of  foreign-born  in  the  present  and  oncoming  gener- 
ation. 

The  importance  of  these  figures  rests  mainly  in  their  significance  in 
showing  the  trend  of  the  immigration  situation  in  St.  Paul  rather  than  as 
a  measure  of  present  conditions,  since  altho  they  are  the  last  available, 
they  are  about  eight  years  old,  and  since  in  the  last  half  of  that  time,  at 
least,  during  the  period  of  the  war,  racial  distribution  of  the  population 
of  St.  Paul  cannot  be  said  to  have  stood  still.  However,  such  signifi- 
cance as  the  available  facts  show  should  be  taken  into  account  and  inter- 
preted as  far  as  the  situation  warrants. 


(8) 


Vital  Statistics 


ST.  PAUL  is  proud,  and  very  naturally  so,  of  its  low  death  rate.  It 
is  impossible,  fortunately  for  the  city's  self-esteem,  to  calculate 
just  how  much  of  the  credit  for  such  a  low  rate  belongs  to  the  peo- 
ple themselves  and  how  much  to  natural  conditions.  However,  notwith- 
standing the  presence  of  natural  aids  to  a  high  standard  of  public  health 
such  as  the  healthful  climate,  lake  water  supply,  and  the  comparatively 
short  haul  of  the  milk  supply,  there  are  still  some  conditions  to  be  reme- 
died, as  a  study  of  the  vital  statistics  of  the  City  will  show. 

General  Death  Rate 

Below  are  given  comparative  death  rates  for  St.  Paul  and  the  State 
of  Minnesota  for  the  years  of  1910  to  1916.  The  rates  for  St.  Paul 
were  computed  from  the  figures  given  in  the  annual  City  health  reports 
for  each  of  the  years,  using  as  a  populational  basis  figures  obtained 
from  the  office  of  the  statistician,  United  States  Census.  Those  for  the 
State  of  Minnesota  are  taken  directly  from  the  annual  Federal  reports  of 
mortality  statistics : 


Table  III. 

Showing  Death  Rates  in  St.  Paul  and  State  of  Minnesota. 

1910        1911        1912        1913        1914        1915        1916 

St    Paul    11.9         10.7        10.2         11.0         11.3         10.7         11.3 

Minnesota     10.9         10.5          9.5         10.4         10.6         10.1         10.7 

1910-16 

11.0 

10.3 

The  mortality  rates  as  given  for  St.  Paul  for  the  above  years  in  the 
City  annual  health  reports  are  somewhat  lower,  being  as  follows:  1910, 
10.88;  1911,  10.15;  1912,  9.81;  1913,  10.01;  1914,  10.50;  1915,  9.62; 
1916,  10.32.  The  difference  probably  results  from  the  use  of  local  popu- 
lational estimates  instead  of  Federal  ones. 

A  comparison  of  St.  Paul's  general  death  rate  with  those  of  the  other 
cities  of  approximately  the  same  population  is  given  below,  the  rates  in 
this  case,  for  St.  Paul  as  well  as  the  other  cities,  being  taken  directly 
from  the  yearly  mortality  reports  of  the  United  States  Census : 


(9) 


Table  IV. 

Showing  Death  Rate  from  All  Causes  in  St.  Paul  and  Other  Cities, 

ip  1 1- 1 6 

City                    1911  1912  1913  1914  1915  1916 

Albany,    N.    Y 20.4  20.1  19.8  19.4  20.0  19.3 

Bridgeport,  Conn,  * 13.9  13.9  14.9  15.0  15.4  19.4 

Cambridge,   Mass 15.2  13.0  13.5  13.2  13.1  13.5 

Columbus,   0 14.3  14.4  15.3  14.8  14.0  15.5 

Dayton,    O     13.7  15.1  16.0  13.8  13.6  15.2 

Fall  River,   Mass 17.4  16.2  17.2  17.3  15.9  17.0 

Grand  Rapids,  Mich 13.6  13.0  13.3  12.9  12.5  12.2 

Indianapolis,   Ind 14.7  15.0  15.7  15.9  14.7  15.6 

Jersey   City,    N.   J 15.8  14.0  14.6  13.8  14.5  14.6 

Kansas   City,  Mo 15.4  15.2  14.8  14.0  14.7  14.5 

Louisville,  Ky 16.1  16.4  16.2  16.5  15.0  15.0 

Lowell  Mass 17.7  17.4  15.9  15.9  16.2  17.3 

Memphis,    Tenn 21.3  21.7  20.8  20.7  19.8  * 

Minneapolis,    Minn 11.5  10.4  11.6  12.0  11.5  12.4 

Nashville,    Tenn 20.5  19.3  17.8  18.4  17.2  *. 

New   Haven,   Conn 16.7  16.5  15.9  16.1  15.7  17.0 

Oakland,   Cal 12.7  12.8  12.5  11.6  11.4  10.5 

Omaha,    Neb 14.3  13.2  13.9  13.8  12.2  14.4 

Paterson,    N.    J 14.6  14.0  13.5  13.5  13.2  14.5 

Portland,    Ore,     10.9  9.5  9.5  9.1  8.4  8.0 

Providence,  R.  1 15.6  15.8  15.2  15.2  14.6  15.8 

Rochester,  N.    ..Y 14.4  14.6  14.6  14.3  13.9  14.4 

Scranton,   Pa.    14.8  14.6  14.8  15.8  14.7  14.4 

Seattle,   Wash 8.8  8.1  8.4  8.1  7.4  7.0 

Spokane,  Wash 11.6  8.4  8.9  8.6  8.1  7.0 

St.  Paul,  Minn 10.9  10.2  11.0  11.4  10.7  11.3 

Syracuse,  N.  Y 14.3  15.2  15.7  14.8  13.2  15.2 

Toledo,    O ....14.9  15.8  16.2  15.5  15.4  18.1 

Washington,   D.   C 18.7  18.3  17.3  16.6  18.1  17.8 

Worcester,    Mass 15.7  16.2  16.4  15.7  15.4  17.8 

^Transcripts  for  deaths  not  received. 

It  is  gratifying  to  note  how  nearly  St.  Paul  heads  the  list  in  low  mor- 
tality. Only  Seattle,  Washington,  and  Portland,  Oregon  show  consist- 
ently lower  rates,— 8.8,  8.1,  8.4,  8.1,  7.4,  7.0  for  the  former,  and  10.9, 

9.5,  9.1,  8.4,  8.0  for  the  latter,  altho  Spokane,  Washington,  after  1911 
with  its  rate  of  11.6  shows  rates  nearly  as  low  as  Seattle,  that  is  8.4,  8.9, 

8.6,  8.1,  7.0. 

Infant  Mortality 

In  another  respect  also  the  statistics  for  St.  Paul  are  gratifying,  that 
is,  in  the  infant  mortality  rates.  We  have  very  few  figures  for  com- 
parison since  infant  mortality  rates  are  notably  difficult  to  get  owing  to 
the  inadequacy  of  birth  registration,  but  what  comparative  figures. we 
could  find  are  set  forth  in  the  following  Table : 


(10) 


Table  V. 

Showing  Number  of  Deaths  of  Infants  under  i  year  per  1,000  Births  in 
St.  Paul  and  Other  Cities,  1910-1916. 

City  1910  1911  1912  1913  1914  1915    1916 

St.  Paul  125.9  99.6    96.3    85.8  82.7  78.0    66.3 

New  Haven    109  112  111  93  98  88 

New    York    126  112  105  102  94  98 

Spring-field,    111 129 

Minneapolis    104  96.7  75.2  85.3  83.4  71.1  82.4 

Richmond,  Va 228  181  172  162  161  127  137 

The  steady  decrease  in  the  infant  mortality  rate  for  St.  Paul  since 
the  big  drop  from  1910  to  1911  is  a  cause  for  congratulation,  altho  in 
view  of  the  utter  lack  of  infant  welfare  work  by  the  Bureau  of  Health 
the  City  can  hardly  claim  much  credit  for  the  good  work.  Moreover, 
the  figures  cannot  be  taken  at  quite  their  face  value  since  the  birth  regis- 
tration in  St.  Paul,  as  in  many  other  cities,  cannot  be  considered  com- 
plete. For  the  year  1916  especially,  there  would  seem  to  be  strong  cause 
for  suspecting  that  the  large  reduction  in  the  rate  is  due  to  incomplete 
registration  of  births  rather  than  to  remarkably  efficient  infant  mortality 
prevention.  However  that  may  be,  and  however  much  more  there  is  for 
St.  Paul  to  accomplish  in  the  line  of  infant  mortality  prevention,  at  least 
it  is  obvious  that  the  city  has  already  a  good  start  and  needs  only  to  con- 
tinue in  the  systematic  reduction  of  the  infant  mortality  rate  shown  in 
the  above  Table. 

Main  Causes  of  Death 

The  main  causes  of  death  in  St.  Paul  for  the  years  1910  to  1916 
have  been  tabulated  from  the  City's  annual  health  reports  for  those  years. 
For  puposes  of  comparison,  a  similar  tabulation  has  been  made  for  the 
State  of  Minnesota,  using  the  figures  in  the  annual  mortality  statistics 
report  of  the  Federal  Census,  and  the  two  Tables  are  given  below : 

Table  VI. 

Showing  Number  of  Deaths  in  St.  Paul  by  Main  Causes,  ipio-ipi6. 

Cause  of  Death                        1910  1911  1912  1913  1914  1915  1916 

Tuberculosis   (all  forms)    ..     294  289  288  315  317  305  307 

Organic  diseases  of  Heart...     204  227  205  218  266  271  305 

Pneumonia   231  241  191  207  285  277  207 

Cancer   180  168  168  163  187  186  205 

Bright's   Disease    118  102  150  149  155  155  191 

Diarrhea  and  Enteritis 161  99  127  122  131  75  97 

Diphtheria  and  Croup 142  66  23  42  69  30  22 

Meningitis    36  34  21  18  20  22  25 

Convulsions    23  17  11  13  4  2  8 

Typhoid    Fever    42  22  23  19  25  18  13 

Scarlet  Fever    58  34  8  18  42  28  8 

Paralysis    15  8  7  8  9  5  8 

Syphilis     11  15  13  13  12  10  9 

Whooping-cough    5  13  11  15  9  12  16 

Measles    22  1  18  5  14  14 

Small-pox     1  2  1  0  0  1  0 

All  other  diseases  1,015  1,048  1,058  1,218  1,153  1,186  1,350 

Total    2,558  2,385  2,306  2,556  2,689  2,597  2,785 

(ID 


Table  VII. 

Showing  Number  of  Deaths  in  Minnesota  by  Main  Causes,  ipio-ipi6. 

Cause  of  Death                         1910         1911         1912         1913         1914  1915         1916 

Tuberculosis   (all   forms)    .  2,270        2,522        2,230        2,342        2,380  2,281        2,382 

Organic  diseases  of     Heart  1,698        1,891         1,912        2,025        2,257  2,279        2,415 

Penumonia    1,806        2,018        1,544        1,768        2,155  2,012        1,957 

Cancer            1,400        1,423        1,498        1,638        1,701  1,780        1,963 

Bright's   Disease 1,051        1,225        1,392        1,441        1,539  1,640        1,739 

Diarrhea  and  Enteritis 

(under  2  years)    1.641           988           764         1,146           978  745           440 

Diphtheria  and  Croup.:...       543           315           168           219           359  192           170 

Meningitis     205           178           126           107           120  138           142 

Convulsions    153           161           152           132           100  98            86 

Typhoid  Fever   668          283           128          235          224  153           124 

Scarlet  Fever  301           189           104           185           333  145           121 

Paralysis    195           163           148           171           170-         158  164 

Syphilis 62            76            80            99           124  112           150 

Whooping  Cough  155           172          210           143           193  165           221 

Measles    247           111             22          207            79  87          288 

Small-pox   10              6              4            12              7  7              1 

All  other  diseases    10,244      10,267      10,006      10,917      10,764  10,802      11,934 

Total   22,649      21,988      20,488      22,787      23,483  22,794      24,297 

The  prevalence  in  St.  Paul  of  the  diseases  mentioned  in  Tables  VI 
and  VII  is  more  easily  seen  when  reduced  to  terms  of  percentage,  and 
accordingly  the  ratios  for  both  City  and  State  have  been  worked  out  as 
follows  for  the  period  of  1910  to  1916  as  a  whole : 

Table  VIII. 

Showing  Number  and  Percentage  of  Deaths  in  St.  Paul  and  Minnesota 
by  Main  Causes,  1910-1916. 

PREVALENCE  IN  ST.   PAUL               PREVALENCE  IN  MINNESOTA 

CAUSE                                                                             %  of  deaths  %  of  deaths 

from  all  from  all 

No.                          causes                              No.  causes 

Tuberculosis  (all  forms) 2,115                  11.84                  16,407  10.36 

Organic  diseases  of  the  Heart.   1,696                   9.44                  14,477  9.14 

Pneumonia 1,639                   9.17                  13,260  8.37 

Cancer    1,257                   7.03                 11,403  7.19 

Bright's    Disease    1,020                  5.71                 10,027  6.33 

Diarrhea  and  Enteritis 812                   4.54                   6,702  4.23 

Diphtheria   and    Croup 394                   2.20                   1,966  1.24 

Meningitis    176                    .99                   1,016  .64 

Convulsions    , 78                    .44                     882  .55 

Typhoid  Fever    162                     .91                    1,815  1.14 

Scarlet    Fever    196                   1.09                    1,378  .87 

Paralysis    60                    .33                   1,169  .74 

Syphilis    ' 83                    .46                     703  .44 

Whooping  Cough   81                     .45                   1,259  .79 

Measles 74                    .41                   1,041  .65 

Small-pox    5                    .03                       47  .03 

All  other  causes    8,028                 44.96                 74,934  47.29 

Total    17,876              100.00               158,486  100.00 

It  is  worthy  of  note  that  in  eight  specific  diseases— tuberculosis,  or- 
ganic diseases  of  the  heart,  pneumonia,  diarrheal  diseases,  diphtheria, 

(12) 


meningitis,  scarlet  fever,  and  syphilis — St.  Paul's  rates  are  higher  than 
those  of  the  State.  The  difference  in  the  rates  are  for  the  most  part  small, 
those  for  tuberculosis,  pneumonia  and  diphtheria  being  the  largest  in 
which  diseases  the  City's  rates  exceed  the  State's  by  1.48%,  .80%  and 
.96%  respectively.  In  the  other  cases  of  rates  excessive  over  the  State's 
the  excess  is  less  than  one-half  of  one  per  cent;  in  syphilis  .02%  an  al- 
most negligible  quantity,  altho  very  possibly  the  city's  percentage  might 
be  considerably  higher  than  one  made  up  of  both  rural  and  urban  factors 
if  the  death  reporting  for  this  disease  were  as  reliable  as  for  other  di- 
seases. 

In  Table  IX  we  see  in  what  proportion  St.  Paul  contributed  to  the 
State's  quota  of  each  of  the  diseases  under  discussion  for  the  period  of 
1910  to  1916. 

Table  IX. 

Showing  Number  and  Percentage  of  Deaths  by  Main  Causes  in  St.  Paul 
of  the  Total  Deaths  in  Minnesota  from  the  Same  Causes. 

CAUSE  No.  deaths  in  No.  deaths  in  %  of  deaths  in  St.  Paul 

Minnesota  St.  Paul  of  deaths  in  Minnesata 

Tuberculosis  (all  forms)    16,407  2,115  12.88 

Organic  diseases  of  the  heart 14,477  1,696  11.71 

Pneumonia    13,260  1,639  12.36 

Cancer    11,403  1,257  11.02 

Bright's   Disease    10,027  1,020  10.10 

Diarrhea  and   Enteritis    6,702  812  12.12 

Diphtheria  and  Croup  1,966  394  20.04 

Meningitis    1,016  176  17.30 

Convulsions     882  78  8.84 

Typhoid  Fever 1,815  162  8.92 

Scarlet  Fever  1,378  196-  14.22 

Paralysis    1,169  60  5.13 

Syphilis    703  83  11.80 

Whooping  Cough   1,259  81  6.43 

Measles    1.041  74  7.10 

Small-pox   47  5  10.64 

All  other  causes   74,934  8,028  10.71 

Total  158,486  17,876  11.28 

The  population  for  St.  Paul  in  1916,  according  to  the  figures  of  the 
Federal  Statistician  was  247,232,  and  that  of  Minnesota  for  the  same 
year  was  2,279,603,  making  the  ratio  of  St.  Paul's  population  to  the 
State's  to  be  10.84.  It  will  be  seen  from  the  above  Table  that  while  the 
ratio  of  the  City's  deaths  to  the  State's  varies  from  considerably  lower 
than  the  populational  ratio,  as  is  the  case  of  paralysis  where  only  5.13% 
of  the  State's  deaths  from  that  disease  can  be  attributed  to  St.  Paul,  to 
a  very  much  higher  figure  where  St.  Paul  is  responsible  for  20.04%  of 
all  deaths  from  diphtheria  throughout  the  State,  the  proportion  of  the 
total  deaths  from  all  causes  in  St.  Paul  is  11.28%  of  the  same  in  the 
State.  This  figure  is  only  slightly  higher  than  the  populational  ratio,  to 
be  sure,  .44%  to  be  exact,  and  the  difference  is  not  unnatural  in  consider- 
ation of  the  urban  factors  involved. 

(13) 


Ed 
> 

& 

© 
H 

>-; 

Ed 


UJ 

z  x 

o  h- 

rr  u. 

<>>  o 

>  «o 


3 


z 


< 

UJ 

o 

X 

I- 


UJ    u_ 
CO    O 


>   ^^ 


W 


CO 
H 

o 


o 

I- 
z 


H 


er>  5 

O     Q 


< 
O 

x 

Cu 

> 
CQ 


< 

a: 
< 

Cu 

UJ 


z 

> 
< 

X 

or 
o 

V5 

z 
o 

p 
o 

or 


O 

h 

<o 

a: 
m 
\- 
o 
< 

< 

X 

o 

h- 
o 

z 


"o 

-o    2 
"5    »- 

w 

•+-  -a 


-a 
o 


J  "5 


tf) 

■A 


5  ^ 


>-»  o_ 


.a    c    « 
U.    o    IT 


■J    £ 


-«  3 
«>  «- 

.H  -E 

-J    o 
<  -c 

(U    -C 

Z  "f- 

ul    u 

2  * 


m  io  h 


spoaay 


uo^i3tf3 


The  most  obvious  of  such  urban  factors  is  that  of  congestion.  To 
show  any  possible  relation  between  mortality  incidence  in  St.  Paul  and 
the  city's  congestion,  a  pin  map  was  prepared  showing  the  location  of 
deaths  in  the  last  five  years  (1913-1917)  due  to  the  following  prevent- 
able causes, — adult  pneumonia,  infant  pneumonia  (infants  under  two 
years),  adult  and  infant  tuberculosis,  diphtheria,  scarlet  fever,  typhoid 
fever,  and  infant  deaths  due  to  all  other  causes  besides  the  above  men- 
tioned ones.  Distinction  between  the  various  causes  was  designated  by 
different  colors,  which  of  course,  do  not  show  in  the  photograph.  How- 
ever, the  general  distribution  of  the  deaths  is  perfectly  obvious  regardless 
of  lack  of  color. 

Together  with  the  map  showing  distribution  of  deaths  we  have  by 
courtesy  of  Dr.  Aronovici  a  map  showing  the  relative  density  of  popu- 
lation in  St.  Paul,  which  was  prepared  for  publication  in  his  report  on 
"Housing  Conditions  in  St.  Paul." 

The  closeness  with  which  the  mortality  incidence  follows  the  increase 
of  congestion  is  plainly  visible.  Also  to  any  one  who  has  read  Dr.  Aron- 
ovici's  above  mentioned  report  there  is  a  strikingly  evident  identity  be- 
tween those  sections  bearing  the  heaviest  brunt  of  mortality  incidence 
and  those  sections  of  the  territory  included  in  his  survey  which  were 
found  to  show  the  worst  housing  conditions  from  all  points  of  view. 
To  show  this  relation  graphically  the  following  chart  of  conditions  found 
by  the  Housing  Survey,  for  which  we  are  also  indebted  to  Dr.  Arono- 
vici, is  presented.  A  comparison  of  the  latter  with  the  photograph  of 
the  pin  map  prepared  for  this  report  will  readily  show  the  interdepend- 
ence of  mortality  incidence  and  bad  housing  conditions  with  all  their  at- 
tendant evils  of  insanitation. 

Another  factor  playing  an  important  part  with  the  prevalence  of  di- 
sease and  death  is  that  of  dependency.  We  are  fortunate  in  having  at 
hand  a  map  prepared  by  C.  C.  Stillman  of  the  United  Charities,  St.  Paul, 
showing  the  distribution  of  cases  of  dependency.  The  map  was  used  in 
the  Housing  Survey  to  show  correlation  of  dependency  with  congestion 
and  bad  housing  conditions.  It  also  shows,  as  can  be  seen  from  a  com- 
parison with  the  mortality  pin  map  of  this  report,  a  marked  correlation 
with  the  distribution  of  deaths  from  preventable  diseases. 

Statistical  Data  for  Specific  Diseases 

MEASLES 

The  mortality  rate  for  measles  has  been  quite  consistently  low  since 
a  drop  in  1911.  The  following  table  compiled  from  the  annual  mortal- 
ity statistics  reports  shows  how  St.  Paul  compares  with  other  cities  in 
this  respect.  Since  the  rate  for  measles  is  characterized  by  wide  annual 
variations  in  cities  of  the  size  of  St.  Paul,  it  is  impossible  to  pick  out 
any  one  city  with  an  absolutely  consistently  low  rate,  St.  Paul's  being 
practically  as  low  as  any. 

(16) 


---T-,,--lv    .   ---.   .V--.--.-.^---v:;-l 


MAP   SHOWING  LOCATION   OF   DEATHS   IN   PERIOD    1913-1917    FROM   CERTAIN 
PREVENTABLE    DISEASES. 


ST.  PAUL 


MAP   SHOWING   DISTRIBUTION   OF   CASES   OF   DEPENDENCY   DEALT   WITH    BY   THE 
UNITED   CHARITIES   OF   THE   CITY   OF    ST.    PAUL   IN   1916. 


Table  X. 

Showing  the  Number  of  Deaths  from  Measles  per  100,000  Population 
in  St.  Paul  and  Other  Cities, 1010-1016. 

City                                             1910       1911  1912  1913  1914  1915  1916 

Akron,  Ohio  17,2          1.4  9.3  5.2  10.0  2.4  47.4 

Albany,  N.  Y 23.9  5.9  6.8  1.9  1.9  24.5 

Bridgeport,    Conn 5.8        17.9  6.4  13.4  28.6  6.8  15.6 

Butte,    Montana    10.2          2.5  24.3  2.4  16.1 

Cambridge,  Mass 3.8          9.4  8.4  9.2  10.9  5.4  7.1 

Camden,    N.    J 12.6        13.4  18.9  5.9  20.1  .0 

Columbus,  0 23.6        11.2  11.9  4.5  11.7  6.7  15.8 

Dayton,   0 1.7         0.8  12.5  4.1  5.7  2.4  1.6 

Denver,  Colo 3.3        21.2  0.4  4.2  4.1  1.2  1.9 

Fall  River,  Mass 17.5        37.5  1.6  58.9  2.4  14.2  30.4 

Grand  Rapids,  Mich 15.5  9.1  4.1  2.3 

Hartford,   Conn 16.1          3.0  9.7  20.9  4.7  1.8  37.0 

Indianapolis,   Ind 17.9          1.2  6.5  6.3  8.1  9.8 

Jersey  City,   N.  J 8.5        15.2  5.3  10.4  4.4  17.7  5.9 

Kansas  City,  Kan 26.6          4.7  1.1  18.5  5.3  3.1  5.0 

Kansas  City,  Mo 28.4          3.1  0.4  22.3  1.1  2.1  14.1 

Lawrence,  Mass 20.8        26.7  18.7  37.4  6.3  30.6  20.9 

Louisville,    Ky 1.3        25.5  0.4  6.0  8.5  2.1 

Lowell,   Mass 28.1        11.9  53.3  19.1  10.8  0.9  25.6 

Memphis,   Tenn 6.1        27.8  2.9  11.4  5.6  2.7  * 

Minneapolis,    Minn 15.8          1.3  3.4  6.0  2.6  3.7  20.4 

Nashville,    Tenn 4.5        53.0  0.9  22.0  7.0  0.9  * 

New  Bedford,  Mass 41.0        11.8  5.8  33.4  3.6  35.7  14.4 

New  Haven,   Conn 4.5          2.2  18.7  1.4  21.5  12.2  5.3 

Oakland,  Cal 4.0        11.5  3.0  15.3  2.6  .0 

Omaha,   Neb 5.6          3.9  0.8  0.8  1.5  8.0  1.8 

Paterson,    N.    J 8.7          1.5  20.7  0.8  9.7  0.7  18.1 

Portland,    Ore 3.8          8.6  0.4  2.4  8.1  1.5  2.7 

Providence,  R.  1 31.9          4.3  33.6  15.8  15.1  9.2  25.1 

Reading,    Pa 14.5        14.3  6.0  17.7  6.5  22.8 

Rochester,  N.  Y 5.9          5.7  11.3  3.4  5.3  3.2  8.1 

Salt  Lake  City,  Utah 3.2        26.8  4.0  12.3  4.6  11.1 

Scranton,  Pa 8.4         2.3  15.5  2.9'       7.1  5.6  3.4 

Seattle,  Wash 2.9          5.1  0.4  11.2  **0.3  **  3.4 

Spokane,    Wash 7.6          5.3  5.8  0.8  **6.6  **  10.6 

Springfield,   Mass 14.05        12.9  7.4  11.3  9.0  3.9  15.1 

St.  Paul,  Minn 14.8  0.4  7.8  1.3  5.0  7.3 

Syracuse,  N.  Y : 8.7        11.3  4.2  15.7  2.7  6.6  .0 

Tacoma,  Wash 2.4         3.4  18.2  **.0  **  8.9 

Toledo,    0 16.5  14.1  7.8  3.8  4.8  33.8 

Trenton,  N.  J ***17.5    ***31.0    ***9.8  ***13.4  ***2.8  ***18.3  ***17.0 

Washington,   D.   C 1.2         6.5  2.0  7.8  0.3  2.0  2.2 

Waterbury,    Conn 8.2        18.5  9.0  17.4  3.6  7.1  13.8 

Wilmington,   Del 1.1         13.5  2.2  15.4  16.2  3.2  27.6 

Worcester,  Mass 15.7          3.3  9.9  10.0  11.4  1.2  34.3 

Youngstown,  Ohio   35.1          7.2  24.3  48.9  12.9  1.9  40.6 

*Transcripts  for  deaths  not  received. 

**Very  low  rate,  due  possibly  to  incomplete  registration  or  to  overestimates  of  popu- 
lation. 

***Rate  of  area  in  which  there  is  a  state  insane  asylum. 

Since  mortality  rates  are  not  the  only  measure  of  the  prevalence  and 
evils  of  disease  the  following  Table  has  been  prepared  showing  the  mor- 
bidity and  fatality  rates  for  measles  in  the  City  of  St.  Paul. 

(17) 


Table  XL 

Showing  the  Number  of  Cases  per  100,000  Population  and  the  Number 

of  Deaths  per  100  Reported  Cases  from  Measles 

in  St.  Paul,  1010-1016. 

No.  cases  No.  deaths  per 

YEAR                                                   Reported  cases              per  100,000  Deaths  100  reported 

population  cases 

1910  1,275        593  22  1.72 

1911  118         57  0  .00 

1912  282         124  1  .35 

1913  1,311        566  18  1.37 

1914  560         235  5  .89 

1915    1,216              -      502  14  1.15 

1916     1,937                     783  14  .72 

1917    2,946                   1,166  12  .40 

It  is  gratifying  to  find  that  altho  the  fatality  rates  vary  considerably 

for  the  different  years  they  never  run  very  high.  The  case  rates  for  the 

disease  vary  also  but  this  is  to  be  expected  considering  the  epidemic  na- 
ture of  measles. 

SCARLET  FEVER 

Table  XII  is  a  comparison  of  St.  Paul's  mortality  rate  for  scarlet 

fever  with  that  rate  for  the  same  disease  in  other  cities  of  approximately 
the  same  population. 

Table  XII 

Showing  the  Number  of  Deaths  from-  Scarlet  Fever  per  100,000  Popula- 
tion in  St.  Paul  and  Other  Cities  1910-1916 

City                                             1910       1911       1912  1913  1914       1915       1916 

Akron,  O .'...12.9        37.3        26.7  10.3  8.7         9.6        '4.4 

Albany,  N.  Y 12.0          1.0  2.0  7.8         2.9            .0 

Bridgeport,  Conn 19.5          2.8        17.4  26.8  16.5          7.6          3.3 

Butte,  Mont 50.9        17.6          9.9  55.9  4.7         2.3         4.6 

Cambridge,  Mass 2.9          2.8          1.9  1.8          3.6          1.8 

Camden,    N.   J 9.5          4.1          3.0  10.9  2.0          1.9         0.9 

Columbus,  0 3.3         4.3          3.1  4.5  1.5          1.4         2.3 

Dayton,   0 9.4         0.8         4.7  4.1  7.3          72        11.0 

Denver,  Colo 17.2          5.0          7.4  22.3  10.6          3.6          1.2 

Fall  River,  Mass 2.5          1.6          7.3  21.8  9.6          4.7          1.6 

Grand  Rapids,  Mich 17.7          5.2         0.8  18.2  17.9         0.8          1.6 

Hartford,    Conn 7.0        22.7        30.0  13.3  4.7         0.9          1.8 

Indianapolis,  Ind 4.3          3.7          4.0  5.1  6.5          3.0          4.7 

Jersey  City,  N.  J 17.1        11.6         9.2  14.3  7.5          5.0         3.9 

Kansas  City,  Kan 10.9          4.7  3.2  7.4          5.2        14.1 

Kansas   City,   Mo 23.2          5.4          5.3  2.2  1.4          1.4        27.5 

Lawrence,    Mass 8.1          3.3          4.4  4.3  3.1          8.1          5.0 

Louisville,    Ky 9.4          3.5          3.9  3.4  5.1          0.8         0.4 

Lowell,   Mass 41.2          4.6          5.5  3.6  1.8                       5.3 

Memphis,  Tenn 5.3          2.3          0.7  8.5  2.1          4.8          * 

Minneapolis,  Minn 16.5          6.1          4.6  18.9  26.2          3.1          4.4 

Nashville,    Tenn 1.8          3.6  1.7  *. 

New  Bedford,  Mass 5.1          1.0  2.8  27.0          7.8          1.7 

New  Haven,   Conn 8.2        10.2          5.7  8.5  4.8          3.4          6.7 

Oakland,    Cal 3.3          1.3  1.1  2.7          0.5            .0 

(18) 


City                                               1910  1911  1912  1913  1914  1915  1916 

Omaha,   Neb 15.3  6.3  3.9  10.7  12.8  14.1  33.8 

Paterson,  N.  J 9.5  10.1  6.9  3.0  0.7  2.2 

Portland,  Ore 10.0  5.9  3.0  4.1  1.9  0.4  0.7 

Providence,  R.  1 6.7  13.4  11.9  5.4  8.2  7.6  6.3 

Reading,    Pa 13.5  15.3  8.9  5.8  5.6  9.1 

Rochester,    N.   Y 21.4  22.0  12.2  8.9  11.0  2.8  0.8 

Salt  Lake  City,  U 39.6  12.4  2.0  2.7  1.8  6.0 

Scranton,  Pa 7.7  6.8  6.6  10.1  2.8  2.8  2.0 

Seattle,    Wash 7.1  2.8  0.7  2.0  **1.0  ^**0.3  .0 

Spokane,    Wash 16.1  6.2  1.7  6.2  **1.5  <**2.1  0.7 

Springfield,    Mass 22.3  3.2  2.1  3.1  1.0  1.0  3.8 

St.   Paul,   Minn 30.2  16.0  4.0  7.8  19.4  12.4  3.2 

Syracuse,    N.    Y 16.7  26.0  7.0  13.0  8.0  0.6 

Tacoma,    Wash 7.1  9.0  1.1  3.0  **2.9  ***0.9  .0 

Toledo,    0 5.9  5.2  9.6  6.7  1.1  4.3  4.0 

Trenton,  N.   r ***10.3  ***7.0  ***2.0  ***26.8  ***26.2  ***3.7    ***2.7 

Washington,   D.   C 4.2  1.2  1.2  4.0  0.3  2.5  1.6 

Waiterbury,  Conn 5.4  22.4  7.7  3.7  17.0  .0 

Wilmington,  Del 12.6  7.9  14.3  2.2  2.1  1.1 

Worcester,   Mass 3.4  8.6  7.2  7.5  4.4  1.9  1.8 

Youngstown,   O ...8.8  4.8  39.3  11,1  4.0  4.8  6.5 

*Transcripts  for  deaths  not  received. 

**Very  low  rate,  due  possibly  to  incomplete  registration  or  to  overestimates  of  popu- 
lation. 
***Rate  of  area  in  which  there  is  a  state  insane  asylum. 

Except  for  the  years  1912,  1913  and  1916  the  rates  in  St.  Paul  are 
fairly  high,  so  high  at  least,  that  St.  Paul  by  no  means  leads  the  list  since 
there  are  13  cities  out  of  the  total  46 — Cambridge,  Columbus,  Indian- 
apolis, Lawrence,  Louisville,  Memphis,  Nashville,  Oakland,  Seattle,  Ta- 
coma, Toledo,  Washington  and  Worcester — with  rates  lower  than  10.0 
per  100,000  population. 

The  morbidity  and  fatality  rates  for  scarlet  fever  in  St.  Paul  are 
contained  in  the  following  table  : 

Table  XIII. 

Showing  the  Number  of  Cases  per  100,000  Population  and  the  Number 
of  Deaths  per  100  Reported  Cases  from  Scarlet  Fever  in  St.  Paul 

1910-1017 


No.  of  caees  No.  deaths  per 

YEAR                                                           Reported  cases                 per  100,000  No.  deaths  100  reported 

population  cases 

1910 1,061                      494  58  5.47 

1911    480                      217  34  7.08 

1912   180                        79  8  4.44 

1913 503                     217  18  3.57 

1914   687                      291  42  6.11 

1915    849                      350  28  3.29 

1916   375                     139  8  2.13 

1917   461                      182  7  1.52 

It  is  to  be  hoped  that  the  last  fatality  rate  known,  1.52  for  1917  is  an 

index  of  a  real  improvement,  since  the  general  run  of  the  previous  ones 
is  higher  than  could  be  wished.     Similar  figures  for  three  of  the  years 

(19) 


under  consideration  are  available  for  Springfield,  111.,  from  the  survey 
of  that  city  and  are  as  follows  :* 

Deaths   per   100  cases    from                      1909            1910  1911            1912  1913 

Scarlet  Fever    1.30            1.95  1.72  2.70 

It  must  be  borne  in  mind  that  Springfield  has  a  considerably  smaller 

population  with  which  to  deal,  but  St.  Paul's  health  service  should  be 
correspondingly  adequate  to  handle  the  problems  of  its  larger  population 

so  that  its  fatalit}'  rate  for  scarlet  fever  may  be  at  least  no  higher  than 
the  standard  achieved  for  Springfield. 

DIPHTHERIA 

Table  XIV  gives  St.  Paul's  death  rate  for  diphtheria  in  comparison 

with  the  rate  for  the  same  disease  in  the  45  other  cities  before  mentioned. 

Table  XIV 

Showing  the  Number  of  Deaths  from  Diphtheria  per  100,000  Population 
In  St.  Paul  and  Other  Cities  1910-1916 

City                                             1910       1911        1912  1913       1914  1915  1916 

Akron,    0 27.3        44.3        50.7  34.8        10.0  15.7  30.9 

Albany,   N.  Y 14.9        24.8        28.5  22.5        12.6  17.4  11.3 

Bridgeport,    Conn 27.3         14.2        14.7  20.5        38.2  26.2  18.9 

Butte,    Mont 15.3          5.0  2.4          4.7  4.7  29.9 

Cambridge,    Mass 22.8        39.4        24.1  12.8        15.4  25.1  14.2 

Camden,    N.    J 66.3        38.0        50.7  39.8        23.4  28.7  27.3 

Columbus,    0 11.5        12.8        20.6  10.5          8.8  11.0  8.8 

Dayton,    0 11.1          9.3        41.5  35.2        17.8  15.1  16.5 

Denver,  Colo 18.6        16.7          5.6  8.0          4.1  3.2  1.5 

Fall   River,    Mass 19.2        22.0        26.1  27.4        20.7  26.0  15.6 

Grand  Rapids.  Mich 10.6        10.3        12.7  43.9        26.8  11.9  7.0 

Hartford,   Conn 34.2        42.5        40.7  28.5        16.8  18.4  20.7 

Indianapolis,   Ind 6.8        17.1         14.6  18.9        11.2  7.9  19.9 

Tersey  City,  N.  J 30.8        21.0        15.3  25.7        31.0  19.7  14.0 

Kansas    City,    Kans 35.1         10.5         11.2  10.9        14.9  32.0  27.2 

Kansas   City,    Mo 21.6        12.4        10.2  12.8        24.1  24.5  28.5 

Lawrence,  Mass 39.3        20.1         12.1  10.7        36.5  33.6  23.9 

Louisville.  Ky 10.7        11.9        11.3  15.0          7.2  5.9  6.7 

Lowell,  Mass 20.6"      15.6        15.6  31.9        23.4  23.2  38.9 

Memphis,   Tenn 16.7        16.5         10.2  10.0        15.4  13.0  *. 

Minneapolis,  Minn 42.9        23.8        13.9  16.8        42.2  17.8  19  0 

Nashville,    Tenn 6.3          8.1          7.1  7.0          9.6  8.6  * 

New  Bedford,  Mass 25  6          9.8        18.2  31.5        18.9  22.7  9.3 

New    Haven,    Conn 12.7        19.0        12.2  16.2        19.4  23.1  16.0 

Oakland,  Cal 7.3          7.0          9.0  13.7        13.1  9.4  12.6 

Omaha,   Neb 13.6        15.0          8.5  16.0        42.8  22.7  21.2 

Paterson,    N.    J 20.6        16.3        20.7  9.8        15.6  13.9  13.7 

Portland,   Ore 22.4        12.3          6.0  5.3        10.0  6.2  2.4 

Providence,    R.    1 21.7        24.7        32.7  29.6        24.1  22.0  29.8 

Reading,  Pa 30.1        38.7        42.0  38.4        31.0  9.3  10.0 

Rochester,   N.    Y 17.3        41.0        27.3  17.4        11.8  7.2  9.3 

Salt   Lake   City,   U 34.2        26.8          4.0  5.7        12.8  27.3  13.6 

Scranton,    Pa 28.4        12.8        25.0  31.7        22.6  27.8  17.0 

Seattle,    Wash 6.3          8.7          4.3  4.4    **  2.2  **0.6  2.0 

Spokane,    Wash 18.0          8.0          5.0  0.8      **3.7  **5.6  0.7 

(For  meaning  of  asterisks  in  Table,  see  p.  21.) 
*Springfield  Survey-Public  Health   Section,  p.  29. 

(20) 


City                                               1910  1911  1912  1913  1914  1915  1916 

Springfield,    Mass 41.3  9.7  16.9  J6.4        12.9  10.7  17.9 

St.   Paul,  Minn 64.0  32.9  10.6  18.6  29.1         12.4  8.9 

Syracuse,   N.   Y 18.8  25.3  17.4  14.3  10.7  10.5  13.5 

Tacoma,  Wash 22.5  10.2  7.4  7.1  **1.9  **0.9  6.2 

Toledo,    0 19.5  24.9  33.4  23.3  17.9  16.5  17.2 

Trenton,   N.  J ***30.8  ***27.0  ***11.8  ***26.8  ***22.5  ***24  7  ***17  0 

Washington,    D.    C 9.3  5.6  4.4  .  7.8  8.2  7.5  9.6 

Waterbury,  Conn 44.8  26.4  21.8  28.6  26.7  15.3  28.7 

Wilmington,  Del 29.7  22.5  11.1  8.8  19.6  11.8  10.6 

Worcester,  Mass 34.8  23.9  21.7  22.5  12.0  13.7  14.7 

Youngstown,   0 37.6  48.2  58.9  47.8  19.9  7.7  5.5 

*Transcripts  of  deaths  not  received. 

**Very  low  rate,  due  possibly  to  incomplete  registration  or  to  overestimate  of  popu- 
lation. 

***Rate  of  area  in  which  there  is  a  state  insane  asylum. 

Altho  St.  Paul  should  not  be  too  proud  of  the  rates  as  shown,  rang- 
ing from  8.9  to  64.0  with  the  majority  of  them  over  15.0,  yet  there  are 
not  many  of  the  cities  cited  with  a  consistently  lower  rate, — only  Nash- 
ville, Seattle,  and  Washington,  whose  rates  for  the  given  years  are  all 
below  10.0. 

The  morbidity  and  fatality  rates  for  diphtheria  in  St.  Paul  also  show 
that  there  is  still  something  to  be  desired  in  the  control  of  this  disease, 
as  is  put  forth  in  Table  XV.    . 


Table  XV. 

Showing  the  Number  of  Cases  per  ioo,ooo  Population  and  the  Number 
of  Deaths  per  ioo  Reported  Cases  from  Diphtheria  in  St.  Paul 

ipio-ipi/ 

No.  of  cases  No.  deaths  per 

YEAR  Reported  cases  per  100,000  No.  deaths  100  reported 

population  cases 

1910    1,402  652  142  10.12 

1911  780  353  63  8.46 

1912  392  173  23  8.42 

1913  611  264  42  6.87 

1914  989  418  69  6.95 

1915  471  153  30  6.37 

1916  457  184  22  4.81 

1917  897  355  40  4.45 

Altho  the  above  fatality  rates  are  not  uncommonly  high,  there  is  no 
cause  for  gratification  in  them,  unless  it  be  in  the  fact  that  they  seem  to 
be  quite  steadily  on  the  decrease. 


(21) 


TYPHOID  FEVER 


Table  XVI  shows  St.  Paul's  death  rate  for  typhoid  fever  in  compari- 
son with  the  other  cities : 

Table  XVI 

Showing  the  Number  of  Deaths  from  Typhoid  Fever  per  100,000  Popu- 
lation in  St.  Paul  and  Other  Cities  1910-1916 

City  1910  1911  1912  1913  1914  1915  1916 

Akron,   0 30.2  42.9  26.7  20.6  31.1  30.1  24.3 

Albany,  N.  Y 14.0  18.8  17.7  27.4  17.5  12.6  7.5 

Bridgeport,    Conn 4.9  3.8  8.3  6.2  3.5  5.1  9.0 

Butte,  Mont 28.0  22.6  2.5  12.1  7.1  9.3  9.2 

Cambridge,  Mass 9.5  2.8  3.7  9.2  1.8  1.8  1.8 

Camden,  N.  J 16.8  9.2  11.1  18.9  14.6  9.6  20.7 

Columbus,  O.   18.1  13.9  19.6  19.1  13.2  13.4  13.0 

Dayton,   0 21.4  18.6  19.1  18.0  11.3  17.5  19.7 

Denver,  Colo 27.5  18.0  15.2  13.5  9.0  6.3  7.3 

Fall  River,  Mass 15.0  14.7  18.0  8.9  9.6  15.0  10.9 

Grand  Rapids,  Mich .28.3  26.7  33.9  18.2  27.6  27.8  16.4 

Hartford,   Conn 19.1  19.8  12.6  22.8  26.2  19.3  17.1 

Indianapolis,    Ind 28.5  25.8  17.8  24.4  25.8  14.3  26.1 

Jersey  City,  N.  J 11.5  7.2  7.8  10.8  7.5  5.7  7.2 

Kansas    City,    Kans 95.5  59.5  25.8  29.4  22.3  15.5  14.1 

Kansas   City,   Mo 54.4  29.9  12.0  21.9  16.3  9.7  11.4 

Lawrence,  Mass 16.2  12.3  13.2  12.8  7.3  8.1  8.0 

Louisville,    Ky 31.7  23.7  21.8  23.2  25.9  13.9  13.4 

Lowell,   Mass 19.7  7.3  10.1  10.0  10.8  16.1  11.5 

Memphis,   Tenn 27.4  65.4  58.9  34.2  42.6  26.7  *. 

Minneapolis,    Minn 58.7  11.9  11.7  12.0  12.5  7.6  5.5 

Nashville,    Tenn 48.9  53.9  32.8  36.9  51.3  37.1  *. 

New  Bedford,  Mass.'  21.5  22.5  18.2  10.2  11.7  20.9  6.8 

New  Haven,  Conn 17.9  24.9  24.4  12.7  15.2  19.7  8.7 

Oakland,  Cal 16.5  14.0  13.7  12.0  6.6  6.8  4.0 

Omaha,    Neb 86.6  18.1  14.0  7.6  4.5  6.1  3.0 

Paterson,    N.   J 7.1  7.0  5.4  8.3  4.5  4.4  4.3 

Portland,  Ore  22.4  19.1  16.6  6.5  6.9  5.1  4.7 

Providence,   R.  1 17.7  12.1  10.2  11.2  11.0  8.0  5.1 

Reading,    Pa 32.1  23.4  28.0  59.0  31.9  18.6  19.1 

Rochester,  N.  Y.  13.7  10.6  11.7  8.9  10.2  6.0  5.0 

Salt  Lake  City,  U 46.0  23.7  19.8  16.1  10.0  7.0  9.4 

Scranton,    Pa 16.9  14.3  10.3  9.4  9.2  12.5  6.1 

Seattle,  Wash 14.2  10.3  7.6  4.7  >*7.0  **2.4  3.2 

Spokane,  Wash 45.4  35.6  17.4  7.0  **12.5  **9.8  2.0 

Springfield,    Mass 14.5  18.3  16.9  20.5  21.9  10.7  5.7 

St.    Paul,    Minn 19,5  10.5  10.6  9.1  11.0  7.0  5.7 

Syracuse,  N.  Y 28.2  16.2  16.7  13.0  10.0  5.9  12.2 

Tacoma,  Wash 21.3  17.0  11.7  12.2  **7.7  **7.4  6.2 

Toledo,    0 37.2  23.1  31.7  41.6  36.9  22.9  22.2 

Trenton,   N.  J ***50.3  ***44.0  ***39.2  ***21.1  ***17.8  ***13.7  ***6.3 

Washington,  D.  C 23.2  22.2  23.0  16.4  11.9  12.0  12.9 

Waterbury,    Conn 20.4  23.7  15.4  13.7  9.7  29.5  11.5 

Wilmington,  Del 37.7  28.2  30.1  23.1  25.0  18.3  29.7 

Worcester,   Mass 15.7  6.0  3.3  5.6  3.8  5.6  3.7 

Youngstown,   0 57.7  44.6  31.2  47.8  39.8  31.6  35.1 

^Transcripts  of  deaths  not  received. 

**Very   low   rate,    due   possibly  to    incomplete  registration    or    to    overestimates    of 

population. 

***Rates  of  area  in  which  there  is  a  state  insane  asylum. 

(22) 


As  is  to  be  expected  considering  the  nature  of  the  City's  water  supply 
and  the  consequent  absence  of  contamination,  the  mortality  rates  for  ty- 
phoid fever  in  St.  Paul  do  not  run  strikingly  high,  but  on  the  other  hand, 
in  view  of  these  considerations  we  might  well  expect  the  rates  to  be  lower 
than  19.5,  10.5.  10.6,  9.1,  11.0  and  7.0  as  listed  in  the  Table.  Espe- 
cially might  we  look  for  such  a  condition  when  we  note  that  three  cities, 
Bridgeport,  Cambridge,  and  Paterson — have  typhoid  rates  lower  than 
10  deaths  per  100,000. 

That  the  fairly  high  death  rate  is  due  to  high  fatality  rather  than  to 
widespread  prevalence  of  the  disease  is  borne  out  by  the  following  Table 
of  case  and  fatality  rates : 

Table  XVII. 

Showing  the  Number  of  Cases  per  100,000  Population  and  the  Number 
of  Deaths  per  100  Reported  Cases  from  Typhoid  Fever  in  St.  Paul 

IOIO-IQI1/ 


YEAR  Reported  cases 

1910   369 

1911   123 

1912   124 

1913   160 

1914 161 

1915   151 

1916   53 

1917  42 

We  can  note  no  steady  improvement  in  the  above  figures,  unless  per- 
haps the  increasingly  low  case  rates  of  the  last  two  years  1916  and  1917 
are  indicative  of  a  change  for  the  better.  Inasmuch  as  typhoid  fever  is 
one  of  the  most  preventable  of  the  communicable  diseases,  St.  Paul  has 
no  great  cause  for  satisfaction  so  long  as  it  remains  a  menace  albeit  a 
comparatively  small  one. 


SMALL-POX 

In  these  times  when  the  weapons  of  science  have  waged  increasingly 
successful  wrar  on  the  once  all  terrifying  scourge  of  small-pox  it  is  to  the 
discredit  of  a  city  to  have  any  mortality  rate  from  this  disease.  Few  of 
the  cities  used  for  comparison  with  St.  Paul  show  any  small-pox  death 
rates,  altho  St.  Paul  itself  does  for  all  but  two  of  the  years  under  discus- 
sion. 

Table  XVIII  shows  St.  Paul's  rates  and  those  of  the  13  other  cities 
which  also  plead  guilty  to  having  deaths  from  small-pox. 

(23) 


No.  of  cases 
per  100.000 
population 

No.  death  8 

No.  deaths  per 

100  reported 

cases 

171 

42 

11.38 

55 

22 

17.88 

54 

23 

18.54 

78 

19 

11.87 

68 

25 

15.52 

62 

18 

11.92 

21 

12 

22.64 

17 

6 

14.29 

Table  XVIII 

Showing  the  Number  of  Deaths  from  Small-pox  per  100,000  Population 
in  St.  Paul  and  Other  Cities  1010-1016. 

City  1910  1911  1912  1913   1914  1915  1916 

Albany,  X.  Y 1.0 

Kansas  City,  Kans 1.2        2.3  1.1 

Kansas    City,    Mo 0.8        3.1        0.4        0.4        1.8        0.3 

Memphis,    Tenn 0.8 

Minneapolis,  Minn 0.3        0.3  0.3 

New  Bedford,  Mass 8.7 

Omaha,    Xeb 0.8 

Portland,  Ore 0.4        0.8  0.4 

Salt  Lake  City,  U 1.1  1.0 

Seattle,  Wash 0.4  *0.3 

Spokane,  Wash 0.9 

St.   Paul,   Minn 0.5        0.9        0.4  0.4 

Tacoma,    Wash 1.1 

Youngstown,   0 1.9 

*Very  low  rate,  due  possibly  to  incomplete  registration  or  to  overestimates  of  popu- 
lation. 

The  rates  for  St.  Paul  are  gratifyingly  low,  as  are  the  fatality  rates 
also,  shown  in  the  following  Table : 


Table  XIX 

Showing  the  Number  of  Cases  per  100,000  Population  and  the  Number 
of  Deaths  per  100  Reported  Cases  from  Small-pox  in  St.  Paul 

1010-1017 

No.  cases  No.  deaths 

YEAR  Reported  Cases        per  100,000        No.  of  deaths         per  100 

population  reported  cases 

1910  170  79  1  .58 

1911  520  235  2  .38 

1912  634  280  1  .15 

1913  310  134  0  .00 

1914   61  26  0  .00 

1915    117  .48  1  .85 

1916    129  52  0  .00 

1917 270  106  0  .00 

It  remains  for  the  city  to  reduce  the  case  rate  to  a  correspondingly 
low  figure,  and  that  should  not  be  difficult  to  do  with  the  easily  available 
preventive  measure  of  vaccination  at  hand. 

TUBERCULOSIS  OF  THE  LUNGS 

Altho  the  rate  of  deaths  from  tuberculosis  of  the  lungs  is  consider- 
ably lower  in  St.  Paul  than  that  in  many  other  cities  of  the  same  size, 
St.  Paul  still  has  no  cause  for  complacency. 

(24) 


Table  XX. 

Showing  the  Number  of  Deaths  from  Tuberculosis  of  the  Lungs  per 
100,000  Population  in  St.  Paul  and  Other  Cities  1910-16 

City              1910    1911    1912  1913  1914  1915  1916 

Akron,  0 74.7    92.7    98.7  91.5  78.5  94.0  85.0 

Albany,  N.  Y 239.1        239.7        206.4  226.7  245.7  261.6  208.5 

Bridgeport,  Conn 178.2        108.6          86.2  83.8  98.0  120.7  118.4 

Butte,    Mont 218.9        220.8        205.2  245.4  224.7  184.6  195.7 

Cambridge,  Mass 245.4        166.9        176.4  184.3  167.6  182.7  172.6 

Camden,    N.   J 124.2        177.8        140.8  149.1  165.9  105.4  121.4 

Columbus,  0 177.5        159.1        145.5  137.4  137.4  132.1  125.2 

Dayton,   O .161.7        143.7        132.9  147.4  121.2  152.2  121.8 

Denver,  Colo 301.6        270.2        271.4  244.7  241.5  235.4  199.0 

Fall  River,  Mass 141.8        136.2        125.7  128.2  146.7  113.5  161.3 

Grand  Rapids,  Mich 101.6          87.0          77.0  54.7  68.2  85.1  64.7 

Hartford,   Conn 154.1         117.5          90.1  102.8  89.7  71.6  103.7 

Indianapolis,  Ind 178.9        154.1        153.5  182.1  175.5  174.0  159.6 

Jersey  City,  N.  J 176.0        166.4        142.5  133.5  139.5  144.6  143.6 

Kansas    City,    Kan 153.6        173.9        157.3  159.2  129.4  132.2  108.6 

Kansas  City,  Mo,   150.0        149.9        146.6  134.0  136.6  157.0  140.7 

Lawrence,    Mass 108.6        139.3        133.9  127.3  93.9  123.2  126.3 

Louisville,  Ky 222.5        210.6        183.6  160.8  185.0  165.8  159.9 

Lowell,    Mass 112.4        114.7        117.7  90.1  95.5  101.7  103.3 

Memphis,   Tenn 250.3        220.2        224.8  243.0  273.0  262.1  * 

Minneapolis,  Minn 121.1        133.7        117.2  116.1  113.5  124.2  117.8 

Nashville,    Tenn 211.7        202.9        193.4  174.0  201.9  201.8  *. 

New  Bedford,   Mass.    ...       112.7        134.2        117.0  114.1  130.4  128.2  145.6 

New   Haven   Conn 146.9        123.6        101.9  112.7  110.7  89.1  95.5 

Oakland,  Cal 126.2        104.7        115.3  106.7  101.1  112.7  94.2 

Omaha,   Neb 123.6         97.8         90.0  90.0  101.3  93.1  101.5 

Paterson,  N.  J 163.2        168.9        116.0  133.1  113.9  121.7  131.5 

Portland,  Ore 83.1          85.0          71.2  64.5  61.4  67.1  58.2 

Providence,  R.  1 153.5        131.8        115.2  129.1  121.6  125.6  134.1 

Reading,    Pa 107.8        102.9          76.1  86.6  112.2  91.1  80.1 

Rochester,   N.   Y 137.0        111.4         95.5  97.5  91.0  100.5  91.9 

Salt  Lake   City,   U 64.2         67.1          48.4  53.0  48.3  39.6  37.5 

Scranton,  Pa 90.5          99.9          75.8  76.5  76.4  72.2  74.2 

Seattle,  Wash 95.1          92.2          77.9  72.1  **66.8  **49.0  55.1 

Spokane,   Wash 88.9          85.4          56.2  67.8  **53.8  **51.1  40.6 

Springfield,    Mass 81.5          87.4         86.4  74.8  96.5  78.5  68.0 

St.   Paul,   Minn 110.9        111.8        104.3  116.2  113.6  106.2  99.1 

Syracuse,   N.  Y 92.7         95.7          89.8  100.4  107.8  85.9  88.0 

Tacoma,    Wash 94.6        113.1        112.7  105.3  **103.5  **46.3  39.9 

Toledo,   0 138.8       .165.3        153.9  160.7  159.7  171.4  168.1 

Trenton,  N.  J ***210.6  ***192.0  ***194.0  ***167.5  ***151.6  ***156.6  ***131.7 

Washington,  D.  C 233.6        218.1        219.1  206.9  181.7  199.6  187.4 

Waterbury,    Conn 127.7        113.4        111.5  100.9  112.7  82.6  112.7 

Wilmington,   Del 162.0        135.2        160.3  129.7  144.5  149.2  139.0 

Worcester,  Mass 103.6        115.1        107.8  101.3  119.2  114.6  133.5 

Youngstown,   0 82.8        102.5        104.0  72.3  83.5  82.3  93.2 

^Transcript  of  deaths  not  received. 

**Very   low   rate,   due   possibly   to   incomplete   registration   or   to   overestimates    of 

population. 
***Rates  of  area  in  which  there  is  a  state  insane  asylum. 

St.  Paul  as  yet  has  achieved  no  material  reduction  but  keeps  its  rate 

at  about  100  deaths  per  100,000  population.  This  is  far  too  high  a  rate 
for  a  disease  so  notably  preventable  as  tuberculosis,  when  other  cities, 

(25) 


such  as  Akron,  Portland,  Salt  Lake  City,  Scranton,  Seattle,  Spokane  and 
Springfield  have  been  able  to  keep  their  tuberculosis  death  rate  below  -100 
deaths  per  100,000  population. 

No  figures  are  available  for  case  and  fatality  rates  since  deaths  from 
tuberculosis  of  the  lungs  are  not  kept  separately  from  those  of  other 
forms  of  tuberculosis  in  the  annual  reports  of  the  City  Health  Bureau. 
It  is  probable  that  they  would  not  be  very  valuable  even  if  available,  since 
the  case  reporting  of  tuberculosis  is  notably  incomplete. 

PNEUMONIA 

The  prevalence  of  pneumonia,  while  not  as  great  in  St.  Paul  as  in 
some  other  cities,  especially  in  Atlantic  coast  cities  where  climatic  condi- 
tions are  a  potent  factor,  is  still  large  enough  to  afford  an  opportunity 
for  further  preventive  work.  Table  XXI  gives  comparative  data  for  St. 
Paul  and  other  cities  on  the  subject  of  pneumonia  mortality. 

Table  XXI. 

Showing  the  Number  of  Deaths  from  Pneumonia  per  100,000  Population 
in  St.  Paul  and  Other  Cities  1910-1916 

Citv  1910  1911  1912  1913  1914  1915  1916 

Akron,  0 117.8  123.1  140.1  149.4  118.3  166.3  220.7 

Albany,   N.   Y 162.4  141.6  189.7  135.8  130.1  168.0  161.3 

Bridgeport,  Conn 167.5  143.6  163.3  184.6  191.7  204.3  357.8 

Butte,    Mont 117.1  148.1  178.0  243.0  177.4  250.0  232.6 

Cambridge,  Mass 182.6  152.8  150.4  170.6  160.4  146.0  159.3 

Camden,    N.   J 221.0  191.1  169.2  198.8  242.0  231.9  235.3 

Columbus,    0 135.9  121.2  119.2  113.8  114.4  126.8  155.9 

Davton,   0 160.0  121.7  124.6  127.8  105.8  140.2  146.2 

Denver,  Colo 135.9  151.8  123.8  109.3  136.9  162.0  122.3 

Fall  River,  Mass 196.0  193.3  201.6  260.5  233.6  200.2  243.8 

Grand  Rapids,  Mich 82.2  117.2  49.9  66.3  75.5  95.4  70.2 

Hartford,    Conn 207.4  240.0  176.4  226.4  205.5  217.5  300.3 

Indianapolis,  Ind 142.7  110.0  132.0  120.6  140.9  142.3  141.8 

Jersey  City,  N.  J 179.7  198.9  173.4  191.2  167.7  193.6  184.4 

Kansas  Citv.  Kans 182.6  158.7  140.4  166.9  131.5  202.4  113.6 

Kansas  City,  Mo 146.4  148.7  110.5  115.4  117.8  156.3  122.5 

Lawrence,    Mass 235.7  197,2  202.0  147.6  179.5  210.8  166.1 

Louisville,  Ky 152.5  125.3  128.2  146.6  149.3  137.1  146.9 

Lowell,    Alass 196.7  147.7  150.8  142.9  150.4  183.7  178.4 

Memphis,    Tenn 196.3  197.7  178.9  165.3  155.7  136.9  *. 

Minneapolis,    Minn 118.4  113.4  91.5  102.6  121.7  111.8  111.4 

Nashville,    Tenn 218.9  222.6  173.0  151.1  173.2  152.6  * 

Xew  Bedford,  Mass 186.5  180.2  164.9  206.0  178.9  184.0  191.3 

New  Haven,   Conn 208.0  212.1  225.4  188.1  193.1  198.5  225.1 

Oakland,  Cal 103.1  107.2  116.5  119.3  86.3  93.3  75.5 

Omaha,    Neb 159.8  172.0  146.6  119.8  129.1  143.4  173.4 

Paterson,  N.  J 161.6  137.1  172.1  158.8  148.9  147.4  197.2 

Portland,  Ore 76.4  76.8  58.0  75.4  60.2  54.2  52.5 

Providence.  R.  I .194.7  166.0  167.9  159.5  161.6  166.8  174.1 

Reading,    Pa 127.6  76.4  92.1  105.3  90.9  83.6  160.3 

Rochester,   N.  Y 131.5  116.2  148.9  155.1  138.7  117.6  121.6 

Salt  Lake  Citv,  U 129.4  103.2  119.6  86.1  99.3  96.9  118.4 

Scranton,    Pa.     207.8  200.6  200.2  208.5  234.9  199.2  190.0 

Seattle,  Wash 81.4  53.0  51.5  64.4  **54.0  **56.8  40.2 

(For  meaning  of  asterisks  in  Table,  see  p.  27.) 

(26) 


City  1910  1911  1912  1913  1914  1915  1916 

Spokane,   Wash 110.7  123.6  59.5  70.9  **61.2  **54.5  49.9 

Springfield,  Mass 184.2  156.5  125.4  152.6  154.2  162.8  192.6 

St.   Paul,  Minn 97.9  92.6  77.3  81.2  112.8  110.7  80.5 

Syracuse,    N.    Y 152.1  119.6  141.4  185.0  139.3  119.3  134.3 

Tacoma,  Wash 85.1  76.9  57.4  71.9  **60.9  **63  8  54 1 

Toledo,  0 127.6  113.9  111.5  89.8  111.3  121.4  156.5 

Trenton,   N.   J ***228.0  ***217.0  ***182.2  ***219.2  ***220.0  ***210  6  ***302  0 

Washington,  D.  C 174.0  164.5  141.2  129.9  131.0  176.8  164.3 

Waterbury,  Conn 191.6  141.1  126.8  186.8  143.0  167.6  165.6 

Wilmington,   Del. 223.6  217.5  169.2  167.1  179.2  210.4  2419 

Worcester,  Mass 190.1  164.3  189.3  174.4  171.8  186.3  230  2 

Youngstown,  0 249.6  229.0  229.9  273.5  217.7  226.8  303.5 

^Transcript  of  deaths  not  received. 

**Very  low  rate,  due  possibly  to  incomplete  registration  or  to  overestimates  of  popu- 
lation. 
***Rate  of  area  in  which  there  is  a  state  insane  asylum. 

The  rates  for  St.  Paul,  97.9;  92.6;  77.3;  81.2;  112.8;  110.7  and  80.5 
respectively  for  the  years,  1910;  1911;  1912;  1913;  1914;  1915  and 
1916  not  only  do  not  show  a  gratifying  decrease,  but  in  fact  except  for 
the  year  1916  tend  in  the  opposite  direction.  It  would  seem  that  the 
comparatively  high  rates  for  the  years  1914  and  1915  are  the  results  of  a 
temporary  and  not  premanent  increase  in  the  prevalence  and  virulence  of 
the  disease,  since  1916  shows  a  drop  to  80.5. 

We  have,  of  course,  no  figures  for  cases  of  pneumonia  and  their  fa- 
tality, since  pneumonia  is  not  a  reportable  disease.  Except  for  the  two 
years,  1914  and  1915,  St.  Paul  stands  well  at  the  head  of  the  list  of  those 
with  comparatively  low  pneumonia  mortality,  and  it  is  to  be  hoped  tha{ 
this  position  will  be  maintained  and  improved  upon. 

The  foregoing  analysis  of  the  vital  statistics  of  St.  Paul  shows  con- 
ditions which  are  on  the  average  good.  But  any  claim  to  absolute  su- 
premacy over  all  other  cities  in  the  standard  of  health  is  unfounded. 
Not  only  does  St.  Paul  not  have  the  lowest  rate  of  all  cities  as  is  current- 
ly believed  in  this  city — in  the  year  1916  when  St.  Paul's  death  rate  from 
all  causes  was  11.3,  Oakland,  Portland,  Seattle  and  Spokane  had  the 
lower  rates,  10.5,  8.0,  7.0,  and  7.0  respectively — but  in  certain  specific 
diseases  also  St.  Paul  frequently  shows  conditions  considerably  worse 
than  in  a  number  of  other  cities.  For  instance,  there  are  13  cities  with 
consistently  lower  death  rates  from  scarlet  fever  than  St.  Paul,  3  cities 
with  lower  rates  from  diphtheria,  3  with  lower  rates  from  typhiod  fever, 
and  7  cities  which  keep  their  mortality  rate  from  tuberculosis  under  100 
per  100,000  population,  while  the  rate  for  St.  Paul  hovers  above  that 
figure. 

Since  these  are  all  cases  of  communicable  disease  markedly  suscept- 
ible to  control,  St.  Paul  should  not  be  content  until  conditions  are  im- 
proved to  at  least  the  standard  set  by  other  cities.  Improvement  should 
not  be  difficult  with  such  natural  aids  to  health  fulness  as  the  city  has  in 
conditions  of  climate,  and  of  water  supply,  but  it  is  to  be  feared  that 
the  city  has  been  relying  heretofore  too  much  on  these  natural  factors, 
and  perhaps  transferring  some  of  the  credit  for  them  to  the  Bureau  of 

(27) 


Health.  From  another  source  also  the  Bureau  gets  credit  which  does 
not  rightfully  belong  to  it,  for  while  infant  mortality  in  St.  Paul  has  been 
decreasing  steadily  year  by  year  and  the  consequent  lower  figures  make 
a  good  showing  in  the  annual  reports  of  the  Bureau  of  Health,  3^et  it  is 
obvious  that  since  the  cit3T  does  practically  no  systematic  work  for  infant 
mortality  reduction,  if  any  one  body  is  to  receive  the  credit  it  is  the 
Baby  Welfare  Association. 


(28) 


Sanitation 

Housing 

Actual  Conditions  and  Legislation 

During  the  spring  and  summer  of  1917  a.  survey  of  the  housing  con- 
ditions in  St.  Paul  was  made  by  the  Housing  Commission  of  the  St.  Paul 
Association  and  the  Amherst  PI.  Wilder  Charity  under  the  direction  of 
Carol  Aronovici,  Director  of  Social  Service  of  the  Amherst  H.  Wilder 
Charity.  Mention  should  be  made  of  the  general  conditions  found  by 
the  survey  in  so  far  as  they  have  a  bearing  upon  the  health  of  the  com- 
munity, but  it  is  not  possible  to  single  out  items  of  striking  and  clear-cut 
importance,  for  as  Dr.  Aronovici  says  in  his  introduction,  "It  must  be 
stated  at  the  outset  that  the  housing  evils  in  this  city  are  no  worse  and 
no  better  than  the  evils  found  in  most  of  the  rapidly  growing  cities  of 
this  country."  * 

The  survey,  of  necessity,  was  confined  to  a  limited  area  but  inasmuch 
as  it  covered  the  homes  and  living  conditions  of  over  21,000  people  in 
districts  of  the  city  selected  because  they  were  typical  of  various  aspects 
of  the  housing  problem,  it  is  evident  that  what  facts  were  ascertained 
have  by  no  means  small  significance  in  a  study  of  the  health  conditions 
of  the  city.  Therefore  it  may  not  be  out  of  place  to  quote  here  some 
of  the  general  conclusions  at  which  Dr.  Aronovici  arrived  in  making  the 
survey  and  interpreting  the  facts  thereby  brought  to  light,  and  which  are 
given  below:** 

"The  Health  Department  is  unable  to  enforce  existing  laws  for  rea- 
sons of  shortage  of  appropriation  and  inadequate  inspection  force." 

"Structural  defects  of  new  buildings  and  the  low  standard  of  con- 
struction prevalent  in  the  earlier  days  of  the  development  of  St.  Paul  are 
more  largely  responsible  for  bad  housing  than  the  habits  and  standards 
of  life  of  the  people." 

"More  than  one-third  of  the  population  whose  homes  were  studied 
belong  to  the  classes  generally  designated  either  as  American  or  of  na- 
tionalities with  high  standards  of  living." 

"There  is  no  serious  problem  of  room  congestion  in  the  homes  of  the 
city  of  St.  Paul,  at  least  in  the  districts  examined.     A  few  cases  of  ex- 

*Housing  Conditions  in  the  City  of  St.  Paul.  Report  presented  to  the  Housing 
Commission  of  the  St.  Paul  Association.  By  Carol  Aronovici,  Ph.  D.,  Director  of 
Social  Service,  Amherst  H.  Wilder  Charity. — p.  7. 

**Housing  Conditions  in  the  City  of  St.  Paul,  p.  7. 

(29) 


cessive  crowding  were  found,  but  they  were  by  no  means  typical  of  the 
general  conditions." 

"There  is  a  superabundance  of  toilets,  the  use  of  which  is  shared  by 
from  two  to  ten  families  with  the  result  that  a  disapproportionate 
amount  of  irresponsible  use,  disrepair  and  general  neglect  were  found." 

"The  lodger  evil  which  is  so  intensely  difficult  to  control  in  eastern 
cities  is  very  much  less  acute  in  St.  Paul.  There  is,  however,  a  most 
serious  problem  of  housing  the  single  men  and  single  women,  which  is 
coupled  with  the  difficulties  to  control  the  rooming  houses  and  hotels  of 
the  city.     The  latter  involves  a  moral  as  well  as  a  health  problem." 

"Almost  sixteen  per  cent,  of  the  land  area  in  the  sections  studied  is 
unoccupied.  The  assessments  show  low  values  which  suggest  the  desir- 
ability of  securing  open  spaces  for  much  needed  park  and  playground 
purposes." 

"The  poor  arrangement  of  the  lots,  the  unscientific  placement  of 
buildings,  the  uncontrolled  heights  of  buildings  and  absence  of  regulation 
regarding  distances  between  walls,  have  caused  a  disproportionate  amount 
of  bad  lighting  and  ventilation  and  many  dark  rooms,  characteristic  of 
the  older  slum  areas  of  the  city  of  New  York." 

"The  failure  to  provide  a  city-wide  zoning '  system  has  done  consid- 
erable damage  to  valuable  property  which  might  otherwise  have  been  pro- 
tected. The  present  zoning  system  is  hardly  adequate  to  meet  the  needs 
of  the  City  of  St.  Paul." 

In  regard  to  housing  legislation  in  St.  Paul,  the  above  quoted  survey 
was  the  means  of  bringing  into  existence  the  comprehensive  and  up-to- 
date  Housing  Ordinance  which  was  passed  by  the  City  Council  in  March, 
1918.  All  that  is  necessary  now  to  insure  good  housing  is  the  proper 
enforcement  of  the  law,  and  it  is  to  be  hoped  that  this  will  be  made  pos- 
sible through  sufficient  funds  for  adequate  sanitary  inspection. 

City  Water  Supply 

St.  Paul  is  favorably  situated  in  relation  to  its  water  supply.  The 
sources  are  a  chain  of  lakes  and  artesian  wells.  The  chain  is  composed 
of  Peltier  Lake,  Centerville  Lake,  Pleasant  Lake,  Sucker  Lake  and  Lake 
Yadnais,  with  a  terminal  at  Lake  McCarron,  and  a  pumping  station  for 
the  high  service  water.  The  supply  is  owned  and  operated  by  the  City. 
Analvses  are  made  by  the  City  Chemist  every  two  weeks.  Until  recently 
the  samples  were  taken  weekly  but  there  was  so  little  variation  that  they 
are  taken  at  less  frequent  intervals  now. 

According  to  the  City  Chemist  the  water  is  not  very  hard  and  has 
never  shown  any  contamination  chemically.  The  bacteriological  analyses 
are  made  by  the  bacteriologist  in  the  Health  Department.  Two  samples 
are  taken  each  week,  one  from  the  terminal  chamber  and  one  from  the 
water  used  in  the  residential  section.  The  results  as  a  rule  have  been 
good.     Of  course,  the  bacterial  counts  run  higher  during  the  summer 

(30) 


months,  but  at  no  time  has  there  been  found  any  contamination — natur- 
ally enough,  since  there  have  never  been  water  borne  epidemics  in  St. 
Paul.  For  purifying  treatment  of  the  water,  copper  sulphate  has  been 
used  as  often  as  necessary,  most  generally  in  the  summer  months,  and 
this  work  has  been  done  under  the  direction  of  the  Botanical  Department 
of  the  University  of  Minnesota.  Since  November  1917  two  motor 
driven  screens  have  been  in  operation  in  the  building  adjacent  to  the 
terminal  chamber  at  McCarron  Pumping  Station,  for  the  elimination  of 
vegetative  matter.  The  particular  kind  of  screen  here  used  is  more  or 
less  of  an  experiment,  but  from  all  reports  a  successful  one.  The  con- 
struction is  very  simple — a  cylinder  closed  at  one  end  so  that  the  water 
let  in  at  the  open  end  is  forced  through  the  fine  meshed  -screen  forming 
the  cylindrical  walls.  As  the  screen  revolves  by  the  motor  attachment  it 
is  cleaned  by  sprays  at  the  top.  The  two  screens  have  been  in  operation 
for  over  a  year  and  have  given  entire  satisfaction. 

According  to  the  annual  report  for  1917  of  the  Board  of  Water  Com- 
missioners, the  percentage  of  service  metered  is  91.2,  while  the  percent- 
age of  consumption  metered  is  64.  This  would  seem  to  indicate  that 
altho  the  unmetered  service  represents  only  8.8%  of  the  total  number  of 
buildings  served,  the  total  amount  of  water  consumed  by  this  service  is 
36%  or  more  than  a  third  of  the  total  consumption  of  water  in  the  City 
of  St.  Paul  This  assuredly  is  a  disproportionately  large  fraction  of  the 
total,  and  therefore  presents  a  strong  argument  for  metering  all  service. 
Such  high  percentage  of  unmetered  consumption  very  probably  accounts 
for  the  high  per  capita  consumption.  According  to  the  authors  of  the 
Health  Survey  of  New  Haven,  Conn.,  "Any  excess  over  a  consumption 
of  50-60  gallons  per  capita  is  always  found  to  be  due  to  waste  through 
leaking  fixtures  and  leaking  street  mains,  and  the  installation  of  meters 
soon  leads  to  the  detection  of  such  waste  and  its  elimination  without  any 
limitation  on  legitimate  use."*  St.  Paul's  consumption  in  gallons  per  day 
to  each  consumer  is  73,  and  while  that  is  by  no  means  as  high  as  New 
Haven's  180,  yet  the  access  of  13  gallons  per  day  to  each  consumer  over 
the  maximum  of  60  mentioned  in  the  New  Haven  Survey  can  in  all 
probability  be  charged  to  the  8.8%  unmetered  service  through  which  is 
consumed  36%  of  the  total  water  used. 

The  above  mentioned  report  of  the  Board  of  Water  Commissioners 
also  shows  approximately  the  proportion  of  the  population  served.  Its 
figures  are  as  follows :  ? 

Estimated  population  276,000. 
Estimated  population  on  pipe  lines  227,000. 
Estimated  population  supplied  217,000. 

According  to  these  figures  there  are  49,000  people,  or  17.75%  of  the 
total  population  not  on  pipe  lines  and  there  are  9,500  people,  or  3.44% 
of  the  total  population  who  are  on  pipe  lines  but  not  taking  advantage  of 

*Health  Survey  of  New  Haven.  A  report  presented  to  the  Civic  Federation  of  New 
Haven  by  Charles-Edward  Amory  Winslow,  James  Cowan  Greenway  and  David 
Greenberg  of  Yale  University.     Yale  University  Press,  1917. 

(31) 


City  water,  making  a  total  of  58,500  people  or  21.9%  of  the  whole  popu- 
lation of  St.  Paul  who  are  not  using  City  water.  This  includes  those 
having  individual  artesian  wells,  for  as  stated  in  the  report  "The  City  of 
St.  Paul  supplies  only  about  60%  of  the  total  water  consumed  within  its 
limits.  The  remaining  40%  of  the  demand  is  supplied  by  individual  ar- 
tesian wells,  for  the  greater  part  supplying  what  would  constitute  the 
larger  consumers."*  The  fact  that  large  concerns  prefer  to  have  their  own 
water  supply  is  not  questioned,  neither  is  the  advisability  of  such  a  course, 
but  even  with  allowance  for  this  legitimate  lack  of  use  of  city  water,  the 
fact  cannot  be  ignored  that  there  are  some  people  without  city  water  who 
are  greatly  inconvenienced  or  even  suffering  without  it.  Without  a  spe- 
cial survey  of  wells  and  springs  which  at  this  time  is  not  feasible,  it  is 
impossible  to  estimate  even  approximately  the  number  of  wells  and 
springs  now  in  use  and  the  proportion  of  the  population  served  by  them. 
That  there  are  such  conditions,  in  some  measure  at  least,  is  attested  by 
pertinent  facts  brought  to  light  in  Dr.  Aronovici's  Housing  Survey.  He 
found  in  the  area  he  surveyed  that  18.36%  of  the  total  number  of  houses 
were  without  City  water,  and  that  in  one  district  the  people  depended  en- 
tirely upon  wells  and  springs,  and  these  were  not  adequate  in  number.** 

Sewerage 

St.  Paul's  sewerage  system  is  for  all  normal  conditions  entirely  ade- 
quate. It  is  true  that  in  storms  which  are  somewhat  heavy  and  of  long 
duration,  the  sewers  which  are  of  the  "combined"  variety  to  take  care 
of  both  household  sewage  and  storm  waste,  become  clogged,  but  a  few 
hours  are  sufficient  to  clear  them  out  again.  All  sewers  with  one  ex- 
ception empty  into  the  Mississippi  River  in  about  twenty  open  outlets. 
This  exceptional  case  consists  of  a  storm  sewer  alone  which  empties  into 
Lake  Cosy  just  above  Lake  Como.  The  flow  of  sewage  is  accomplished 
almost  entirely  by  gravity,  for  which  reason  radical  changes  or  improve- 
ments, such  as  the  installation  of  a  purifying  plant  for  instance,  would 
be  decidedly  difficult,  if  not  impractical  to  undertake,  inasmuch  as  such 
a  proceeding  would  necessitate  the  division  of  the  "combined"  system  and 
consequent  inadequacy  of  the  flow  by  gravity.  Fortunately  there  seems 
to  be  no  real  necessity  for  radical  changes  since  for  normal  demands  the 
"combined"  system  is  adequate,  and  since  in  spite  of  open  outlets  to  the 
river,  no  indications  of  a  need  for  purification  have  appeared.  The  river 
water  is  not  used  for  drinking  purposes,  and  as  far  as  being  a  nuisance  is 
concerned  it  undergoes  the  process  of  self  purification  of  all  running  wa- 
ters. The  only  possible  danger  arising  from  river  pollution  lies  in  the 
fact  that  the  Harriet  Island  Public  Baths  are  near  at  hand.  It  would 
seem  advisable  that  the  water  where  the  baths  are  located  be  tested  for 
pollution,  but  no  evidence  of  such  tests  was  found. 


*  Annual  Report  of  the  Board  of  Water  Commissioners  for 
**Housing  Conditions  in  the  City  of  St.  Paul,  pp.  36,  37. 


1917.,  p.  23. 
1,  pp.  36,  37. 

(32) 


Out  of  a  total  of  829.68  miles  of  streets  there  are  422.27  miles  of 
sewerage,  or  50.89%.  However,  it  is  impossible  without  making  a  special 
and  detailed  survey  of  the  sewerage  conditions  and  facilities  to  discover 
just  what  proportion  of  the  population  of  the  city  is  having  the  advan- 
tages of  city  sewerage.  We  know  that  there  are  approximately  34,000 
sewer  connections  in  the  city,  which  means  when  we  multiply  by  five  to 
the  family  and  add  on  a  few  for  the  office  buildings,  that  probably  two- 
thirds  of  the  total  population  are  using  the  City  sewers.  That  there  are 
many  private  privies  and  cisterns,  however,  is  a  well  known  fact  to  any- 
one at  all  familiar  with  the  conditions  and  especially  to  persons  who  have 
read  the  previously  mentioned  Housing  Survey  in  which  Dr.  Aronovici 
states  that  28.69%  of  the  houses  he  studied  were  without  sewers  and  that 
30.37%  of  the  total  number  cyt  toilets  were  located  in  the  yard.*  Of 
course,  we  must  remember  that  since  his  figures  apply  only  to  a  limited 
area  and  that  the  one  in  which  examples  of  the  worst  conditions  might 
be  expected  to  be  found,  the  percentage  of  houses  depending  upon  cis- 
terns and  yard  privies  out  of  the  city's  total  number  of  homes  would  not 
be  nearly  as  great ;  but  with  all  due  consideration  of  this  fact  it  is  obvious 
that  St.  Paul  has  an  immediate  health  problem  in  the  elimination  of  such 
drags  upon  her  sanitation  as  the  presence  of  private  cisterns  and  privies 
is  bound  to  be. 

Garbage  and  Refuse  Disposal 

The  business  of  garbage  collection  and  disposal  was  originally  in  the 
hands  of  the  Health  Department,  but  the  provisions  of  the  new  charter 
removed  it  to  the  Department  of  Public  Works,  the  change  taking  place 
July  1,  1914.  At  present  collection  is  made  partly  by  the  City,  and  part- 
ly by  private  collectors  paying  an  annual  $5.00  license  fee.  There  are 
50  licensed  collectors,  and  30  municipal  teams  assigned  to  garbage  collec- 
tion, and  also  3  municipal  teams  for  the  collection  and  removal  of  dead 
animals.  All  the  garbage,  whether  municipally  or  privately  collected  is 
fed  to  hogs,  the  municipally  collected  portion  being  sold  to  hog  farms 
just  outside  of  the  city  limits.  Collections  are  made  twice  a  week  in  sum- 
mer and  once  a  week  in  winter.  There  are  1 1  inspectors  to  see  that  the 
rules  are  complied  with,  and  to  make  arrests  if  their  educational  work 
(verbal  instructions  and  printed  matter  on  garbage  collection)  does  not 
produce  results. 

The  cost  of  garbage  collection  to  the  City  was  $44,800.43  for  the 
year  1917.  The  receipts  from  the  sale  of  garbage  and  hides  of  dead  ani- 
mals and  from  license  fees  amounted  to  $5,183.53.  For  the  previous 
year,  the  total  expenditure  was  $43,902.13  and  the  receipts  $7,587.17. 
This  decrease  in  the  receipts  is  undoubtedly  due  to  the  present  patriotic 
attempts  at  food  conservation  as  is  stated  in  the  section  on  garbage  dis- 
posal in  the  1917  annual  report  of  the  Department  of  Public  Works.** 

^Housing  Conditions  in  the  City  of  St.  Paul,  pp.  "25  and  36. 
**Annual  Report  of  Commissioner  of  Public  Works,  1917,  p.  75. 

(33) 


In  the  same  report  the  Commissioner  of  Public  Works  also  says  "In  the 
matter  of  garbage  disposal  some  method  must  be  adopted  which  will  con- 
serve all  the  valuable  elements,  such  as  grease,  fertilizer,  etc.  We  are 
being  educated  in  food  conservation  and  our  ideas  in  regard  to  food 
wastes  are  rapidly  changing.  I  am  fully  convinced  that  the  garbage  re- 
duction method  is  the  one  that  should  be  adopted  here."*  Since  St.  Paul 
is  already  paying  a  moderately  large  sum  for  her  garbage  disposal  and  not 
getting  the  most  satisfactory  results  from  an  economic  and  sanitary  point 
of  view,  it  seems  only  reasonable  to  suppose  that  the  City  will  be  willing 
to  pay  a  slightly  larger  sum  in  order  to  have  an  up-to-date  system  suited 
to  the  city's  needs. 

There  is  no  routine  form  of  refuse  disposal  in  St.  Paul.  Household- 
ers must  pay  the  city  scavengers  to  hard  ashes  and  rubbish  to  the  city 
dumps  which  are  seven  in  number,  and'patrolled  by  laborers  who  level 
down  the  refuse  as  it  is  unloaded  to  prevent  too  much  unsightliness  and 
also  the  depositing  of  insanitary  articles,  such  as  garbage  or  dead  ani- 
mals. When  we  consider  how  valuable  ashes  and  unburnable  rubbish 
would  be  if  regularly  collected  by  the  City,  and  used  to  build  up  the  Upper 
and  Lower  Levees  now  comparatively  worthless  because  of  periodical 
floods,  it  seems  strange  indeed  that  St.  Paul  has  been  so  lax  and  irre- 
sponsible in  regard  to  refuse  disposal. 

*  Annual  Report  of  Commissioner  of  Public  Works,  1917,  p.  5. 


(34) 


Health  Agencies 


Public  Health  Agencies 

Relation  of  Health  Bureau  to  General  City  Government 

The  new  Charter  of  1914  gave  to  St.  Paul  the  Commission  form  of 
government,  under  which  there  are  six  Commissioners, — the  Commis- 
sioner of  Finance,  Commissioner  of  Public  Works,  Commissioner  of 
Public  Safety,  Commissioner  of  Education,  Commissioner  of  Parks, 
Playgrounds  and  Public  Buildings,  and  the  Commissioner  of  Public  Util- 
ities, all  of  whom  are  elected  to  the  Council  by  the  people  and  appointed 
to  their  respective  departments  by  the  Mayor.  The  Department  of  Pub- 
lic Safety  is  the  one  in  which  we  are  immediately  interested,  since  what 
is  commonly  known  as  the  Health  Department  is  technically  the  Bureau 
of  Health  of  the  Department  of  Public  Safety.  Besides  the  Bureau  of 
Health  there  are  four  other  bureaus  in  this  Department,  those  of  Police, 
Fire  Protection,  Police  and  Fire  Alarm  Telegraph,  and  General  Admin- 
istration. The  Commissioner  of  Public  Safety  is  ex-officio  the  Chief 
Health  Officer  of  the  Cit)^. 

DUTIES  AND  POWERS  OF  BUREAU 

The  general  duties  and  powers  assigned  to  the  bureau  of  Health  by 
the  new  Charter  are  contained  in  the  following  quotation  from  that  in- 
strument : — 

"General  Health  Powers.  Sec.  373.  The  council  on  recommenda- 
tion of  the  said  commissioner  shall,  by  ordinance,  give  the  said  commis- 
sioner and  said  health  officer  such  powers  and  impose  upon  them  such 
duties  as  will  enable  them  fully  to  protect  the  public  health  and  the  sani- 
tary condition  of  the  city.  Such  health  officer  shall  also  be  the  sanitary 
adviser  of  all  city  officers.  Said  commissioner,  by  and  through  the 
bureau  of  health  shall  have  the  power  of  abating  any  nuisance  upon  such 
notice  and  by  such  methods  as  the  council,  by  ordinance  shall  prescribe ; 
shall  have  the  power  of  controlling  or  taking  measures  to  control  all  con- 
tagious, infectious  diseases  within  said  city;  to  placard  all  infected  hous- 
es and  buildings;  shall  have  full  charge  of  such  small-pox  or  detention 
hospitals  as  said  city  may  establish  or  has  established;  and  in  case  of 
pestilence  or  epidemic,  actual  or  impending,  take  such  measure  as  he  may 
in  good  faith  deem  necessary  to  insure  the  public  health  or  safety.  Said 
commissioner  shall  take  such  measures  as  in  the  opinion  of  the  health 

(35) 


officer  may  be  necessary  to  prevent  the  spread  of  small-pox  or  other  con- 
tagious and  infectious  disease;  he  shall  have  the  power  to  quarantine, 
placard  and  disinfect  any  house  or  building  or  order  it  to  be  done ;  close 
the  same  until  so  disinfected;  and  subject  to  the  approval  of  the  council, 
he  may  order  all  boats,  trains,  and  other  conveyances  bringing  persons 
or  goods  to  the  city  to  be  quarantined  and  compel  persons  or  corporations 
operating  the  same  to  take  such  steps  as  may  be  necessary  to  protect  the 
public  health.  It  shall  be  the  duty  of  said  commissioner  to  see  to  it  that 
all  persons  so  quarantined  shall  receive  proper  medical  attendance,  nurs- 
ing, food,  and  quarters ;  shall  decide  upon  the  advice  of  the  health  officer 
when  persons  so  quarantined  shall  be  discharged  therefrom  and  what  pre- 
cautions shall  be  taken  before  their  discharge  for  the  protection  of  the 
public  health ;  and  shall  keep  at  such  quarantine  such  police  force  neces- 
sary to  enforce  the  orders  of  said  commissioner  and  the  health  officer. 
Said  commissioner  with  the  approval  of  the  council  shall  have  power  to 
establish,  equip  and  maintain  such  quarantine  stations,  hospitals  and 
other  buildings  as  may  be  necessary  for  the  preservation  of  the  public 
health.  He  shall  provide  proper  blanks  and  forms  for  all  returns  and 
data  for  vital  statistics,  and  shall  secure  a  proper  registry  of  births,  deaths 
and  other  necessary  statistics  within  said  city.  He  shall  cause  to  be  vac- 
cinated free  of  charge  and  give  certificates  thereof  to  all  persons  apply- 
ing therefor.  Said  commissioner  shall  have  the  power  of  abating  and 
correcting  any  condition  considered  by  said  health  officer  to  be  detri- 
mental to  the  public  health  and  the  sanitary  condition  of  the  city.  He 
shall  enforce  all  state  laws  relating  to  the  public  health  and  shall  have 
full  sanitary  control  of  all  places  and  institutions  within  the  city  and  may 
require  from  all  persons  in  administrative  control  of  hospitals,  asylums, 
dispensaries,  prisons,  schools,  theaters  and  other  places  of  amusement  or 
recreation  to  make  such  reports  as  may  aid  in  making  safer  the  public 
health.  It  is  hereby  made  the  duty  of  every  physician  and  midwife 
within  said  city  to  report,  in  such  manner  as  the  commissioner  may  direct, 
all  births  and  with  such  other  facts  deemed  pertinent  by  said  commis- 
sioner, and  all  physicians  shall  register  and  report  in  such  form  as  may 
be  prescribed  by  said  commissioner,  all  deaths  of  which  he  has  knowledge, 
within  twenty-four  hours  after  he  has  learned  of  said  deaths.  The  cor- 
oner shall  report  to  said  commissioner  within  forty-eight  hours  after 
it  is  completed  the  result  of  any  inquest.  All  physicians  shall  report  in 
such  manner  as  the  said  commissioner  shall  direct  all  cases  of  contagious 
diseases.  Said  commissioner  with  the  approval  of  the  council  shall 
make  such  regulations  and  rules  as  may  be  necessary  for  the  interment 
and  removal  of  all  dead  bodies.  Said  commissioner  shall  have  jurisdic- 
tion over  all  lakes  and  water  courses  in  Ramsey  county  to  the  same  ex- 
tent as  though  located  within  the  city. 

The  council  by  proper  ordinances  shall  make  effective  and  define  in 
detail  all  powers  and  duties  hereinbefore  imposed  and   granted,   and 

(36) 


such  other  powers  and  duties  as  may  be  necessary  to  conserve  the  public 
health. 

All  persons  whatever  violating  the  provisions  of  the  charter  or  ordi- 
nances enacted  in  pursuance  thereof,  all  rules  and  regulations  of  the 
bureau  of  health  concerning  the  public  health  and  sanitation,  or  who  shall 
interfere  with  any  health  officer  in  the  performance  of  his  duties  shall  be 
guilty  of  a  misdemeanor  and  shall  be  subject  to  a  fine  not  to  exceed  one 
hundred  ($100.00)  dollars  or  imprisonment  not  to  exceed  ninety  (90) 
days,  or  both." 

"Removing  nuisances.  Sec.  374.  The  council,  by  ordinance,  may 
empower  the  said  commissioner  to  remove  and  abate  or  cause  the  same 
to  be  removed  or  abated,  any  nuisance,  any  substance,  matter,  omission 
or  thing,  which  said  commissioner  may  regard  as  dangerous  to  the  health 
or  as  impairing  the  sanitary  condition  or  good  order  of  the  city,  being  or 
lying  in  any  street,  alley,  water,  excavation,  building,  erection,  place,  lot 
or  grounds  and  may  designate  a  place  to  which  the  same  may  be  removed. 
He  shall  serve  a  notice  on  the  owner,  occupant  or  agent  of  any  lot,  build- 
ing or  premises  aforesaid  ordering  the  things  aforesaid  to  be  removed 
therefrom  within  such  time  as  the  council  shall  by  ordinance  prescribe, 
and  that  in  case  of  non-compliance  the  same  will  be  done  by  the  said  com- 
missioner at  the  expense  of  the  owner  of  said  premises.  The  said  com- 
missioner shall  after  such  time  has  expired  proceed  to  remove  such  things 
aforesaid,  determine  the  cost  thereof,  charge  the  owner  and  the  premises 
therewith  and  not  later  than  the  1st  day  of  October  of  each  year  certify 
to  the  County  Auditor  the  amounts  so  charged  against  such  premises, 
lots  and  places  together  with  a  description  of  the  premises  and  the  sup- 
posed owner  thereof  as  nearly  as  practicable  and  such  charge  shall  be 
collected  and  collection  enforced  in  the  same  manner  as  taxes  against  the 
said  premises.  Such  charges  shall  be  a  perpetual  lien  on  said  premises 
until  paid.  Provided,  however,  that  where  no  owner,  occupant  or  agent 
can  be  found  or  the  same  is  unknown,  then  said  commissioner  may  pro- 
ceed without  such  notice." 

"Employes — Policemen.  Sec.  375.  Every  officer  and  employe  of  the 
bureau  of  health,  in  the  performance  of  any  duty  imposed  by  law,  this 
charter,  ordinances  in  pursuance  thereof,  or  any  order  or  direction  of  the 
commissioner  or  the  health  officer  shall  have  and  be  vested  with  all  the 
powers  of  a  policeman." 

In  addition,  the  Commissioner  of  Public  Safety  as  Chief  Health 
Officer  of  the  city  is  given  control  and  supervision  of  the  public  baths 
situated  on  Harriet  Island, — 

"In  charge.  Sec.  376.  The  commissioner  of  public  safety,  as  chief 
health  officer  of  the  city,  shall  manage,  control  and  supervise  the  public 
baths  on  Harriet  Island  and  the  grounds,  buildings  and  institutions  con- 
nected therewith  and  adjacent  thereto." 

"Appoint  Employes.  Sec.  377.  He  shall  appoint  and  remove,  sub- 
ject to  the  charter  and  ordinance  in  pursuance  thereof,  all  such  assist- 

(37) 


ants  and  employes  and  at  such  compensation  as  the  council  by  an  admin- 
istrative ordinance  shall  provide  and  prescribe." 

"Rules.  Sec.  378.  With  the  consent  of  the  council,  by  administra- 
tive ordinance,  he  shall  make  and  enforce  rules  and  regulations  to  govern 
the  use  of  such  baths  and  the  buildings  and  grounds  appertaining  there- 
to." 

The  inspection  of  food,  hotels  and  restaurants  comes  also  under  the 
jurisdiction  of  the  Commissioner  of  Public  Safety : — 

''Food  Inspection — Hotels  and  Restaurants.  Sec.  379.  The  com- 
missioner of  public  safety  shall  administer  and  enforce  all  laws  and  ordi- 
nances relating  to  the  inspection  of  milk,  meats  and  other  food  sub- 
stances, and  also  all  laws  and  ordinances  relating  to  the  inspection  of 
hotels  and  restaurants,  tenements  and  lodging  houses.  The  council  shall 
have  power  by  ordinance  to  make  effective  the  duties  in  this  section  pre- 
scribed, and  to  compel  by  proper  penalties  all  dealers  to  conform  to  such 
regulations  as  shall  fully  protect  the  public  health." 

Furthermore  according  to  Section  380.  "The  commissioner  of  pub- 
lic safety  shall  supervise  and  control  the  maintenance  and  operation  of  all 
public  comfort  stations;  appoint  and  remove  all  such  attendants  and 
employees  therefor  as  the  council  by  an  administrative  ordinance 
may  provide  and  at  such  compensations  as  it  may  prescribe,  and  with  the 
consent  of  the  council  make,  prescribe  and  enforce  all  rules  and  regula- 
tions for  the  orderly  public  use  thereof."  And  altho  very  obviously  the 
charter  makes  no  stipulations  as  to  which  of  the  five  divisions  of  the  de- 
partment of  public  safety  shall  be  the  Commissioner's  instrument  for  su- 
pervising the  public  comfort  stations,  the  Health  Bureau  is  the  one  to 
which  this  work  has  been  assigned. 

In  any  analysis  or  discussion  of  the  powers  of  the  Health  Department 
as  set  forth  above  in  the  quotations  from  the  new  Charter,  it  must  be  ad- 
mitted at  the  outset  that  there  are  various  ambiguities,  discrepancies  and 
inconsistencies  in  the  wording  used.  Attention  was  called  to  this  matter 
by  Dr.  G.  B.  Young  of  the  United  States  Public  Health  Service  in  his 
study  of  public  health  conditions  in  St.  Paul,  and  since  his  findings  still 
hold  true  in  this  respect  it  seems  decidedly  apropos  to  quote  from  his  re- 
port as  follows : — 

"It  is  difficult  to  escape  the  conclusion  that  when  the  charter  was  pre- 
pared section  373  was  obtained  by  selecting  sentences,  clauses,  or  ordi- 
nances from  the  law  then  existing  in  St.  Paul  or  elsewhere  and  consolidat- 
ing them  without  consideration  of  their  coherency  and  without  reference 
to  other  charter  sections  limiting  or  even  nullifying  the  provisions  of 
this  section.  For  example :  The  commissioner  'shall  have  the  power  to 
quarantine,  placard,  or  disinfect  any  house,  or  order  it  to  be  done,'  but 
he  'shall  decide  upon  the  advice  of  the  health  officer,  when  persons  so 
quarantined  shall  be  released.'  In  other  words,  the  commissioner  can 
impose  quarantine  without  consulting  the  health  officer,  but  he  can  not 

(38) 


terminate  it  without  the  latter' s  approval.     Other  contradictory  provi- 
sions might  be  cited. 

There  is  similar  confusion  in  the  language  relating  to  ordinances  and 
rules.  For  example :  Physicians  must  report  contagious  diseases  'in 
such  manner  as  the  said  commissioner  shall  direct,'  which  implies  the 
power  to  enforce  rules  of  his  own  making,  and  yet  later  in  the  same 
section  it  is  expressly  provided  that  the  council  "shall  'by  proper  ordinance 
make  effective  and  define  in  detail  all  powers  and  duties  hereinbefore,  im- 
posed and  granted.' 

In  the  penalty  clause  reference  is  made  to  'the  provisions  of  the  charter 
and  the  ordinances  enacted  in  pursuance  thereof  and  to  'rules  and  regula- 
tions of  the  bureau  of  health,'  evidently  having  in  mind  in  the  latter  case 
the  idea  that  the  bureau  of  health  would  establish  its  own  administrative 
regulations  and  rules  of  procedure. 

Yet. the  charter  (sec.  116  p.  27)  says,  'Every  act  or  bill  which  shall 
*  *  *  *  prescribe  *  *  *  *  the  procedure  for  the  performance  of  any  admin- 
istrative act,  or  promulgate  any  rule  or  regulation  *  *  *  *  shall  be  ex- 
pressed and  done  under  administrative  ordinance.' 

Section  375  gives  full  police  power  to  all  officers  and  employees  of 
the  bureau  of  health. 

Section  379  provides  that  the  commissioner  of  public  safety  shall  'ad- 
minister and  enforce  all  laws  and  ordinances  relating  to  the  inspection  of 
milk,  meat,  and  other  food  substances  and  also  laws  and  ordinances  relat- 
ing to  the  inspection  of  hotels,  restaurants,  tenement  and  lodging  houses' 
— all  this  in  direct  contradiction  of  section  432  (as  above)  which  says 
the  commissioner  of  parks,  playgrounds,  and  buildings,  'shall  enforce  all 
laws  of  the  State  and  all  ordinances  of  the  city  of  St.  Paul  applying  to 
buildings  within  said  city  whether  relating  to  their  planning,  construction, 
maintenance,  repair,  fire  protection,  or  any  other  matter.'  "  * 

Unquestionably  the  provisions  for  health  administration  contained  in 
the  new  Charter  are  not  the  clearest  and  best  defined  possible  and  this,  of 
course,  means  that  St.  Paul  must  labor  under  difficulties  in  achieving 
efficient  health  service.  However,  what  it  can  do  in  the  way  of  stretch- 
ing the  provisions  of  the  Charter  to  its  needs,  it  does.  For  instance  in 
the  case  of  the  contradiction  cited  above  in  assigning  the  inspection  of 
hotels,  restaurants,  tenements  and  lodging  houses  to  both  the  Commis- 
sioner of  Public  Safety  and  to  the  Commissioner  of  Parks,  Playgrounds 
and  Public  Buildings,  altho  technically  there  is  a  chance  for  overlapping 
of  work  and  consequent  friction,  practically  it  works  out  that  each  de- 
partment takes  the  responsibility  of  inspection  of  those  features  that  are 
of  particular  interest  to  it — food  and  sanitation  in  the  case  of  the  Health 
Department  and  structural  condition  in  the  Department  of  Parks,  Play- 
grounds, and  Public  Buildings.     Certainly  it  is  admirable  that  the  Bureau 

*Public  Health  Reports  January  12,  19,  1917.  Public  Health  Administration  in  St. 
Paul,  Minn.,  by  G.  B.  Young,  Surgeon  United  States  Public  Health  Service,  pp.  49 
and  SO. 

(39) 


of  Health  has  done  all  that  it  has  in  smoothing  out  practically  the  techni- 
cal difficulties  that  the  poorly  constructed  health  provisions  of  the  Charter 
have  put  in  the  way,  and  it  is  to  be  hoped  that  all  the  elasticity  possible 
will  be  used  in  construing  the  Charter  since  at  best  that  instrument  does 
not  aim  for  the  broadest  and  most  progressive  health  work  to  be  desired. 

Organization  of  Bureau 

FUNCTIONS  AND  QUALIFICATIONS  OF  EMPLOYEES 

The  final  responsibility  for  the  work  of  the  Bureau  rests  on  the  Health 
Officer,  who  according  to  the  stipulations  of  the  Charter  must  be  a  li- 
censed physician  of  not  less  than  five  years'  practice.  There  is  also  a 
Deputy  Health  Officer  whom  the  Charter  requires  to  be  a  licensed  physi- 
cian of  not  less  than  three  years'  practice.  His  duties,  other  than  second- 
ing the  work  of  the  Health  Officer  and  acting  for  him  in  case  of  the  lat- 
ter's  absence  or  incapacity,  are  in  the  control  of  communicable  diseases. 
The  remaining  members  of  the  Bureau  of  Health  staff  are  qualified  for 
their  positions  by  passing  civil  service  examinations  and  their  several  titles 
with  corresponding  duties  are  as  follows : 

Chief  Inspector  who  is  in  charge  of  the  office  and  the  field  forces,  who 
at  times  may  himself  do  special  field  work  and  who  looks  after  the 
publication  of  the  monthly  bulletin. 

Senior  Clerk  Typist  who  has  charge  of  checking  births  and  deaths,  en- 
tering them  in  records,  and  who  keeps  all  records  except  those  of 
contagious  diseases. 

Stenographer  who  takes  care  of  all  communications,  records  of  conta- 
gious diseases  and  reporting  of  same  to  library  board,  school  board 
and  private  institutions. 

Bookkeeper  who  keeps  the  accounts  and  who  is  solely  in  charge  of  all 
requisitions. 

Statistician  who  copies  birth  and  death  certificates,  issues  burial  permits 
and  certified  copies  of  births  and  deaths. 

Bacteriologist  who  makes  examinations  for  the  presence  of  diphtheria, 
tuberculosis,  typhoid  and  rabies,  and  who  analyzes  samples  of  water, 
both  drinking  water  and  that  from  swimming  pools,  and  milk  and 
cream. 

Laboratory  Assistant  who  helps  the  bacteriologist  and  keeps  the  records 
in  the  laboratory. 

Laboratory  Helper  who  washes  the  instruments  and  utensils  in  the  labor- 
atory. 

Food  Inspector,  three  Meat  Inspectors,  Dairy  Inspector,  Live  Stock  In- 
spector, fourteen  Sanitary  Inspectors,  Superintendent  of  Small-pox 
Hospital, — all  of  whose  special  duties  will  be  elaborated  later.  Sup- 
erintendent of  Harriet  Island  Public  Baths. 

(40) 


COORDINATION  OF  FACTS  THRU  OFFICE  RECORDS 
AND  TABULATIONS 

The  City  Bureau  of  Health  has  already  had  various  suggestions  made 
to  it  regarding  the  improvement  of  its  record  keeping  inasmuch  as  not 
only  Dr.  Young  in  his  Survey  of  the  department  advised  certain  changes 
and  additions,  but  owing  to  the  facts  disclosed  by  his  report  the  St.  Paul 
Association  was  prompted  to  prepare  a  set  of  forms,  the  use  of  which 
was  in  the  opinion  of  that  body  necessary  to  the  highest  efficiency  of  the 
work  of  the  City  Bureau  of  Health. 

None  of  the  forms  suggested  by  the  St.  Paul  Association  are  in  use 
now  in  the  Health  Bureau,  and  altho  the  department  made  a  considerable 
number  of  changes  as  a  result  of  Dr.  Young's  Survey,  the  changes  and 
additions  in  the  system  of  record  keeping  were  not  so  great  that  there  is 
not  still  room  for  improvement.  In  view  of  this  fact  we  have  compared 
the  record  blanks  now  in  use  in  St.  Paul's  Health  Bureau  with  those  used 
by  the  Health  Departments  of  over  forty  other  cities  of  approximately 
the  same  population.  As  a  result  of  this  comparison,  by  culling  out  the 
valuable  blanks  of  other  cities  which  St.  Paul  does  not  use,  and  eliminat- 
ing those  which  are  not  necessary  in  this  city  or  which  are  excelled  by 
similar  blanks  used  here,  we  have  drawn  certain  conclusions  regarding 
improvements  needed  in  the  record  keeping  system  of  St.  Paul's  Bureau 
of  Health,  and  they  are  given  herewith : 

Record  blanks  for  the  work  of  food-stuff  inspection. 

St.  Paul  has  comparatively  few  blanks  for  recording  general  food  in- 
spection. (Milk  and  dairy  inspection  we  shall  consider  separately). 
There  is  a  memorandum  score  slip  for  use  in  places  where  foods  are 
prepared  for  sale  or  sold  which  is  used  for  meat  and  general  food  inspec- 
tion alike,  a  daily  report  blank  for  each  of  those  two  divisions  and  a  file 
card  used  in  both, — these  comprising  all  the  blanks  used  in  this  division. 
A  monthly  report  blank  of  inspections  made — a  compilation  of  the  daily 
reports — would  be  of  value  from  the  point  of  view  of  departmental  effi- 
ciency as  well  as  that  of  statistics.  At  the  present  time  no  food-handling 
places  except  hotels  and  restaurants  are  licensed,  which  explains  the  lack 
of  license  certificates.  Regulations  should  be  made,  however,  for  such 
licensing.  It  might  well  be  done  under  one  general  form  to  include  all 
places  dispensing  food — grocery  stores,  meat  markets,  confectionery 
stores,  soda  fountains,  etc.  The  scoring  of  food  handling  places  which 
is  now  done  on  a  limited  scale  because  of  inadequate  force  and  on  one 
score  card  illy  adapted  to  diversified  uses,  should  be  done  in  greater 
quantity  and  recorded  on  separate  cards  whenever  the  material  warrants 
such  separation. 

For  recording  the  data  acquired  in  milk  and  dairy  inspection  St. 
Paul's  blanks  are  good  as  far  as  they  go  but  do  not  go  far  enough  to 

(41) 


cover  all  problems  arising.  There  is  a  file  card  for  milk  analysis  in  the 
bacteriological  laboratory,  an  analysis  card  for  each  dairy  or  producer, 
which  seems  to  be  much  of  a  repetition  of  part  of  a  larger  card  used  for 
each  producer,  having  space  for  the  score  record,  test  record,  analysis 
record  and  disposition  of  product,  and  daily  report  of  tuberculin  testing. 
Cards  found  in  use  by  other  cities  which  St.  Paul  would  do  well  to 
incorporate  in  its  own  system  are  as  follows  : — 

Monthly  report  of  inspection  of  dairies  and  live  stock. 

Milk  complaint  card. 

Rejection  tag  for  milk  can. 

Producer's  and  retailer's  certificate  or  a  milk  permit. 

Order  to  improve  dairy  conditions. 

Milk  inspection  card  at  train  or  station. 

Bottling  plant  score  card. 

License  for  milk  dealers  and  storekeepers  selling  milk,  and  persons  conveying  milk 
for  sale. 

Order  to  have  cows  ready  for  tuberculin  test  (to  be  sent  not  sooner  than  5  days 
before  examination). 

File  card  for  tuberculin  test. 

File  card  for  physical  examination  of  cattle.  (At  present  no  such  sxamination 
other  than  the  tuberculin  test  is  made  by  the  city,  but  one  should  be  inaug- 
urated and  results  kept  on  record.) 

Notification  to  milk  man  of  presence  of  communicable  disease. 

Dairy  index  to  contagious  diseases. 

Veterinarian's  certificate. 

Notice  of  violation  of  tuberculosis  test. 

Record  blanks  for  Sanitary  Inspection. 

St.  Paul  has  very  few  blanks  for  the  recording  of  sanitary  data — only 
a  daily  report  for  the  sanitary  inspectors,  a  daily  report  for  the  hotel  in- 
spector, application  for  hotel  license,  file  card  for  complaints,  and  report 
of  nuisances  inspected. 

A  monthly  report  both  for  the  sanitary  police  and  for  the  hotel  in- 
spector would  be  an  important  addition  to  the  daily  reports,  that  for  the 
sanitary  police  to  include  a  tabulation  of  the  nuisances  inspected.  Re- 
garding the  hotel  inspection  some  attempt  should  be  made  to  co-ordinate 
the  records  of  the  City  with  those  of  the  State  in  this  department.  Also 
the  score  sheet  compiled  by  the  City  Hotel  Inspector  but  not  used  because 
of  inadequate  inspection  force  might  well  be  used  as  the  basis  for  separate 
score  cards  for  hotels  and  restaurants  if  a  large  enough  force  could  be 
provided  so  that  the  work  of  scoring  could  be  adequately  done. 

St.  Paul  has  no  system  of  sanitary  inspection  of  theaters  and  in  con- 
sequence no  score  card  or  record  of  the  existing  conditions  in  such  public 
gathering  places  is  available.  The  importance  of  such  a  system  of  in- 
spection and  recording  can  hardly  be  questioned. 

Altho  the  importance  of  sanitary  inspection  of  houses,  particularly 
lodging  and  tenement  houses,  can  hardly  be  over  emphasized,  St.  Paul  has 
no  system  for  recording  such  work.  Inasmuch  as  the  data  collected  in 
the  course  of  any  inspection  is  of  considerable  value,  especially  when  court 
litigations  are.  to  be  resorted  to,  it  is  essential  to  have  proper  blanks  in 

(42) 


use,  and  accordingly  it  is  suggested  that  such  cards  as  are  used  in  the 
cities  of  New  York,  Boston,  Chicago,  Cleveland,  Minneapolis  or  some 
other  of  the  numerous  cities  in  which  such  inspection  system  is  in  use 
be  provided,  with  such  changes  as  local  conditions  require.  Such  a 
record  card  should  contain  provisions  for  the  recording  in  addition  to  the 
actual  conditions  found,  adequate  data  regarding  the  frequency  of  in- 
spection, action  taken  and  results  accomplished. 

Other  blanks  used  in  the  cities  under  comparison  which  would  help 
the  sanitary  division  of  St.  Paul's  Health  Bureau  are  as  follows : — 

Notification  to  have  weeds  cut. 

Application  for  analysis  of  water  from  well. 

Notification  that  well  water  is  unsafe. 

Application  for  license  and  license  to  maintain  stable. 

Stable  registration  card. 

Office  record  of  ownership  of  stables  and  number  and  kind  of  animals  therein. 

Application  for  permit  and  permit  to  remove  contents  of  cesspool  or  vault. 

Report  of  cause  of  delay  of  abatement  by  inspectcor. 

Record  of  sanitary  conditions  of  barber  shops. 

(Chiropodists  and  Manicurists.) 
Record  of  laundry  inspections. 
Order  of  abatement  of  nuisance. 

Record  blanks  for  Communicable  Disease  Control. 

St.  Paul  has  a  goodly  list  of  record  blanks  for  use  in  communicable 
disease  control.     They  are  as  follows : 

Tuberculosis  Division : — 

Card  for  physician's  report  of  case. 
Case  card  for  office  file. 
Nurse's  daily  report. 

Card  for  street  index  showing  living  cases,  deaths,  removals  and  renovations  des- 
ignated by  different  colors. 
Sheet  for  complaint,  and  inspector's  report  of  same. 
Letter  for  following  up  doctor's  report. 

Letter  to  physician  signing  death  certificate  for  unreported  case  of  tuberculosis. 
Dispensary  examination  file  card. 
Negative  sputum  card  in  Bacteriological  Laboratory. 
Positive  sputum  card  in  Bacteriological  Laboratory. 
Records  of  sputum  examinations. 

All  Other  Diseases : — 

Card  for  reporting  case  of  reportable  disease. 

Loose  leaf  disease  record  as  reported  by  physician. 

Medical  inspector's  daily  report. 

Daily  list  of  contagious  diseases. 

Monthly  report  of  contagious  diseases  by  wards. 

Epidemiological  report  on  typhoid. 

Social  history  sheet  for  small-pox  patient. 

Bacteriological  laboratory  card  for  examination  of  diphtheria  culture.  (Sent  to 
physician.) 

Bacteriological  laboratory  card  for  examination  of  diphtheria  culture.  (Sent  to 
City  Hospital.) 

Bacteriological  report  of  diphtheria  examination  (Sent  to  Health  Dept.  and  Dept. 
of  Hygiene.) 

Bacteriological  card  for  examination  for  typhoid  (if  positive  sent  to  City  Hos- 
pital.) 

(43) 


Bacteriological  card  for  examination  of  rabies. 

Bacteriological  card  for  any  examination  sent  to  sender  of  sample. 
Bacteriological  card  for  special  examination   (all  unclassified.) 
Bacteriological  record  of  Widal  examinations. 
Certificate  of  freedom  from  communicable  disease. 

Certificate  of  vaccination  (should  be  changed  to  be  given  only  for  successful  vac- 
cinations.) 

The  list  of  blanks  used  in  the  control  of  tuberculosis  seems  very  com- 
plete. Some  additions  might  be  made  to  the  cards  and  forms  for  record- 
ing work  in  other  diseases,  however,  as  a  study  of  those  used  in  other 
cities  shows.     Such  additions  might  be  as  follows : — 

Office  record  for  each  communicable  disease  (typhoid,  diphtheria,  scarlet  fever,  infan- 
tile  paralysis,    cerebrospinal   meningitis,   etc.) 
Report  to  library  of  books  in  house  where  there  is  contagious  disease. 
Card  for  office  file  for  each  of  contagious  diseases. 
Card  reporting  quarantine. 

Permit  to  attend  school  for  child  living  in  rooms  outside  of  quarantine. 
Card  to  employer  to  exclude  from  work  person  living  in  quarantined  rooms. 
Agreement  of  employe  to  reside  outside  quarantined  rooms. 
Permit  to  employe  to  enter  quarantined  premises. 
Card  from  quarantined  person  reporting  to  Health  Bureau  recovery  from  disease  and 

readiness  for  removal  of  quarantine. 
Office  card  for  release  of  quarantine. 
Order   for  disinfection. 

Certificate  of  discharge  from  small-pox  hospital,  or  of  release  from  quarantine  of  ex- 
posed person. 

Record  blanks  for  Vital  Statistics : 

The  report  and  record  blanks  used  in  the  division  of  vital  statistic? 
cover  practically  all  necessities.     They  are  as  follows : — 

Record  of  birth  (city.) 

Record  of  birth  (state.) 

Supplemental  birth  report. 

Birth  certificate. 

Birth  certificate  given  to  parents. 

Monthly  report  of  births. 

Monthly  report  of  births  by  wards. 

Municipal  weekly  morbidity  report  to  U.  S.  Pub.  Health  Service. 

Certificate  of  death   (city). 

Certificate  of  death   (state). 

Certificate  of  death  given  to  any  one  who  wishes. 

Monthly  report  of  deaths. 

Monthly  report  of  deaths  by  wards. 

Monthly  report  of  burials. 

Two  or  three  additions  might  be  made  to  the  above  list,  as  for  in- 
stance, a  letter  to  physician  reporting  death  from  unreported  reportable 
disease  asking  why  disease  was  not  reported : 

Application  for  transcript  of  record. 

Certificates  of  search  of  records  of  births  and  deaths. 

Monthly  report  of  deaths  by  causes  and  wards. 

Use  of  Instructive  Leaflets. 

The  instructive  cards  and  leaflets  used  by  the  St.  Paul  Bureau  of 
Health  are — Rules  Governing  the  Control  of  Communicable  Diseases 
(for  physicians)  ;  Directions  for  Vaccination  and  After  Care;  Anti-spit- 

(44) 


ting  Ordinance ;  Milk  and  Cream  Ordinance ;  and  a  poster  to  educate  the 
public  as  to  the  dangers  of  flies. 

Other  leaflets  in  use  in  some  of  the  cities  under  comparison  which 
might  well  be  added  to  St.  Paul's  list  are : — 

Regulations  for  barbers  and  barber  shops. 

Ordinance  for  licensing,  regulating  and  inspecting  hotels. 

Extract  from  laws  on  bakeries. 

Ordinance  regulating  butchers  and  butcher  shops. 

Ordinance  regulating  sanitary  conditions  of  stores  selling  food  stuffs.     ,, 

Rules  for  care  of  milk  in  the  home. 

Rules  governing  the  handling  and  bottling  and  sale  of  pasteurized  milk. 

Instructions  to  dealer  in  milk. 

Regulations  for  cemetery  keepers  and  undertakers. 

Leaflets  on  all  contagious  diseases — for  public,  not  physicians. 

The  general  conclusions  which  must  be  drawn  from  all  the  foregoing 
comparisons  of  record  blanks  in  use  in  St.  Paul  and  those  in  other  cities 
are: — 

1.  That  the  machinery  for  record  keeping  in  the  Health  Bureau  of 
this  City  is  on  the  whole  incomplete  and  poorly  coordinated. 

2.  That  blanks  for  recording  some  of  the  data  are  entirely  lacking, 
which  lack  not  only  makes  it  impossible  to  ascertain  the  grade  of  work 
done  along  these  lines  and  the  results  accomplished,  but  also  leaves  it  a 
matter  of  uncertainty  whether  or  not  any  such  work  is  actually  being 
done. 

3.  That  the  lack  of  some  record  blanks  and  the  incompleteness  and 
poor  coordination  of  the  others  detracts  from  clearness  and  accuracy  of 
analyses  of  conditions  found  and  of  the  tracing  of  results  of  the  policy 
followed. 

New  blanks  should  be  prepared  and  put  in  use  which  will  make  the 
system  more  nearly  complete,  and  such  blanks  with  those  now  in  use 
should  be  so  coordinated  that  a  clear-cut  cross  section  of  work  done  may 
at  all  times  be  available,  and  that  the  detailed  steps  of  the  policy  followed 
may  be  so  evident  as  to  facilitate  further  progress. 

Food  and  Meat  Inspection 

FOOD  INSPECTION 

The  city  food  inspection  is  in  the  hands  of  one  inspector  who  inspects 
and  scores  for  sanitation  all  food  handling  establishments  except  those 
dealing  in  meat  or  dairy  products.  He  has  under  his  care  about  70 
bakery  shops,  35  candy  factories,  35  commission  houses,  60  peddler  wa- 
gons, 7  ice  cream  factories,  6  pop  factories,  and  grocery  and  confection- 
ery stores  so  numerous  that  he  cannot  properly  look  after  them  all  or  even 
keep  account  of  their  number.  Without  a  doubt  he  should  have  an  as- 
sistant, but  so  far  the  need  has  not  been  filled.  He  also  aims  to  be  pres- 
ent at  fruit  auctions  on  railroad  cars  to  see  that  rules  of  sanitation  are 
complied  with.  The  results  of  the  scoring  are  not  published  in  any  way 
except  as  the  list  of  places  scored  in  the  annual  report.     The  records  of 

(45) 


scoring  were  not  in  shape  for  tabulation  later  than  1917,  and  those  pro- 
cured in  that  year  were  for  the  months  of  September,  October,  and  No- 
vember only.  The  places  then  investigated  were  classified  in  two  groups, 
bakeries  and  like  places,  and  candy  factories  and  like  places.  A  tabula- 
tion of  these  records  has  been  made  as  follows : 

Score  Bakeries,  etc.  Sept.,  Oct.  1917  Candy  Factories,  etc. 

Oct.  and  Nov.  1917 

50-60  2 

60-70  14  4 

70-80 36  13 

80-90 16  3 

90  and  over   4  8 

Total    72  28 

This  is  not  a  remarkably  large  number  of  scores  from  which  to  draw 
conclusions,  but  what  figures  there  are  obviously  tend  to  give  a  fair  av- 
erage. In  the  case  of  the  bakery  inspection  56  out  of  a  total  of  72,  or 
77 .77%  are  scored  70  points  or  above,  while  for  candy  factories  the  per- 
centage of  those  scored  at  70  or  above  is  considerably  higher,  85.71%, 
altho  due  allowance  must  be  made  for  the  fact  that  less  than  half  as 
many  inspections  were  made  for  candy  factories  as  for  bakeries. 

The  only  food-handling  places  licensed  are  hotels  and  restaurants, 
with  the  exception  perhaps  of  peddlers,  but  their  licenses  are  granted  by 
the  City  Clerk,  where  licensing  is  more  for  city  revenue  than  for  the 
protection  of  the  health  of  the  people. 

There  are  not  many  prosecutions,  perhaps  six  or  seven  according  to 
the  food  inspector,  during  this  last  year,  1918.  Whether  this  shows 
merely  that  the  Bureau  of  Health  considers  this  inspection  educational 
rather  than  punitive,  or  whether  the  small  number  of  prosecutions  are 
due  to  failure  to  inspect  and  prosecute,  we  are  not  prepared  to  say.  The 
inadequacy  of  the  force  of  inspection  would  lead  to  the  latter  conclusion. 

There  are  no  laboratory  facilities  in  the  City  Health  Bureau  for  an- 
alysis of  food,  consequently  the  division  of  food  inspection  deals  only 
with  sanitary  conditions,  leaving  the  enforcement  of  pure  food  laws  to 
the  State  and  Federal  governments.  The  State  has  a  division  of  food 
inspection,  which  not  only  inspects  for  sanitation  all  food  shops  and  meat 
markets,  but  analyzes  samples  for  adulteration.  There  are  5  inspectors 
throughout  the  State,  one  of  whom  spends  practically  all  his  time  in  St. 
Paul.  Just  how  much  overlapping  of  work  there  is  between  the  State 
and  City  food  inspectors  can  be  only  a  matter  of  conjecture.  Since 
neither  side  reports  a  knowledge  of  the  other's  findings,  there  doesn't 
seem  to  be  a  considerable  amount  of  co-operation  between  the  two ;  but 
of  course,  it  must  be  remembered  that  there  are  quite  different  schemes 
of  work  involved  in  each  case,  for  while  the  city  bends  it  energies  toward 
producing  a  high  standard  of  sanitation,  that  is  a  secondary  aim  in  the 
State  work,  its  primary  concern  being  the  keeping  of  food  stuffs  chemi- 
cally up  to  the  standard  required  by  State  law. 

(46) 


The  amount  of  Federal  food  inspection  accomplished  in  St.  Paul  is 
part  of  the  work  done  in  the  entire  district  which  consists  of  Minnesota, 
North  and  South  Dakota,  Wisconsin  and  the  northwest  part  of  Michigan. 
For  this  territory  there  are  at  present  two  inspectors,  altho  their  work 
by  no  means  comprises  the  total  amount,  since,  owing  to  the  efficient  co- 
operation of  the  State  Department  of  Food  Inspection,  many  cases  for 
investigation  come  up  to  the  Federal  Bureau  indirectly.  Altho  most  at- 
tention is  paid  to  violations  of  pure  food  laws,  yet  wherever  Federal  in- 
vestigation finds  insanitary  conditions  the  matter  is  at  once  reported'  to 
the  proper  authorities  in  the  City  or  State  Health  Departments.  The 
Federal  Bureau  for  Food  and  Drug  Inspection  considers  the  conditions 
in  St.  Paul  reasonably  good ;  exact  figures  for  prosecutions  are  not  avail- 
able but  the  Federal  Food  Inspector  states  that  during  the  last  year  there 
have  been  very  few  case.^  against  St.  Paul  manufacturers, — altho  in  this 
respect  one  must  bear  in  mind  that  St.  Paul  is  not  predominantly  a  food 
manufacturing  city. 

MEAT  INSPECTION 

Inspection  of  meat  in  St.  Paul  is  separate  from  that  of  other  food. 
There  are  three  inspectors  with  definite  assignments  as  follows : — One 
takes  the  east  half  of  the  city,  one  the  west  half,  and  the  third  inspects 
commission  and  slaughter  houses,  and  has  charge  of  following  up  com- 
plaints, endorsing  licenses  and  making  any  investigations  asked  for.  A 
considerable  amount  of  meat  comes  under  the  interstate  shipment  law, 
and  therefore,  is  Federally  inspected  at  the  South  St.  Paul  yards.  In- 
cluding pork,  about  99%  of  which  is  destined  for  interstate  commerce 
and  consequently  under  Federal  inspection,  of  all  the  meat  consumed  in 
St.  Paul  about  75%  is  Federally  inspected.  Of  beef  alone  the  figure  is 
lower,  only  about  66%  of  which  is  inspected  by  the  United  States  Govern- 
ment. It  is  not  compulsory  for  the  City  to  inspect  the  remainder  of  meat 
not  Federally  inspected,  but  practically  this  is  done.  Also  the  inspector  who 
has  charge  of  slaughter  houses  endeavors  to  be  present  at  the  time  of 
slaughter  in  order  to  hold  both  ante  and  post  mortem  examinations.  The 
only  meat  handling  places  that  are  licensed  are  the  retail  establishments. 
Prosecutions  are  few,  4  or  5  per  year,  for,  as  in  the  case,  of  other  in- 
spection work,  the  aim  is  educational  rather  than  punitive,  and  prose- 
cutions are  made  only  when  the  case  is  one  of  wilful  misdemeanor.  In 
condemning  meat  no  cards  are  used  to  show  that  the  meat  is  condemned 
Or  held  for  inspection,  except  in  the  case  of  meat  bought  by  contract, 
when  a  certificate  of  condemnation  is  given  if  the  receiver  asks  for  it,  to 
show  that  the  meat  was  unfit  for  consumption  so  that  he  may  not  be  the 
loser  by  the  transaction. 

A  list  of  the  places  scored  by  the  Meat  Inspector  is  given  in  the  an- 
nual report,  but  no  tabulation  is  made  to  show  the  conditions  found  by 

(47) 


the  scoring.     Accordingly  the  scores  made  from  January  to  October, 
1918,  have  been  tabulated  as  follows  : 

Score                                                 June  July          Aug.          Sept.          Oct.  Total 

Under  50 1  1 

50-60  2  2 

60-70  4  1  5 

70-80  11  2               1               4               47  65 

80-90  39  1                               31  71 

Over  90  24  3  27 

Total    81  2               2               4               82  171 

It  will  be  noticed  that  there  are  no  scores  given  for  months  earlier 
than  June,  and  that  in  July  and  August,  the  two  months  out  of  all  the 
year  in  which  food-handling  places  need  attention  because  of  tempera- 
ture conditions,  only  4  scores  were  made.  Barring  these  criticisms,  how- 
ever, the  results  of  the  scoring  are  remarkably,  good.  The  City  is  to  be 
congratulated,  and  the  Health  Bureau  particularly,  on  the  standard  of 
sanitary  excellence  which  must  prevail  in  its  meat  handling  stores  when 
95.32%  of  those  scored  show  a  score  of  70  or  over,  and  more  than  half 
or  57.31%  achieve  80  points  or  over. 

As  has  been  stated  the  State  Food  Inspector  working  in  St.  Paul  in- 
spects meat  also,  but  he  inspects  for  adulteration  only  and  not  disease. 
The  State  Live  Stock  Sanitar}'-  Board  looks  after  all  infectious  and  con- 
tagious diseases  among  animals  throughout  the  State  besides  doing  a  cer- 
tain amount  of  tuberculosis  testing. 

One  marked  defect  in  St.  Paul's  food  and  meat  inspection  is  the  lack 
of  any  law  requiring  the  medical  examination  of  food  handlers.  It  is 
needless  to  dwell  upon  the  folly  of  requiring  high  standards  of  cleanli- 
ness in  surroundings  alone,  when  the  person  handling  the  food  or  meat 
may  be  shedding  all  sorts  of  malignant  germs  over  the  city's  food  and 
meat  supply.  A  State  law  would  be  an  excellent  way  of  bettering  the 
situation  inasmuch  as  its  results  would  be  more  far  reaching,  but  a  city 
ordinance  would  be  a  step  in  the  right  direction  as  far  as  St.  Paul  is  con- 
cerned. 


The  Milk  Supply  and  Dairy  Inspection 

The  City  milk  supply  comes  from  about  1000  herds,  including  that 
from  the  "shippers,"  i.  e.,  producers  living  so  far  outside  the  city  that 
they  have  to  ship  their  milk  by  train.  No  milk,  however,  is  shipped  from 
any  point  farther  away  than  Northfield,  Minnesota,  (a  distance  of  about 
fifty  miles),  and  most  of  the  milk  shipped  from  a  distance  comes  from 
places  within  a  radius  of  ten  miles.  The  total  amount  of  milk  sold  in 
the  city  is  about  28,000  gallons  daily,  of  which  16,000  or  57.1%  is  pas- 
teurized, and  12,000  or  .42.9%  is  sold  raw.  Of  the  pasteurized  milk 
7,000  gallons  come  into  the  city  by  wagons  and  9,000  by  train.  There 
are  six  pasteurizing  plants,  and  they  are  all  of  high  grade,  doing  the 

(48) 


work  by  the  holding  system  (heated  to  140°  to  145°,  for  thirty  minutes) 
and  having  their  equipment  in  good  sanitary  condition.  All  pasteuriza- 
tion is  done  in  bulk,  however,  and  none  in  the  bottle.  A  part  of  the  raw 
milk  sold  is  certified,  but  it  is  a  very  small  part,  the  exact  amount  of 
which  it  is  impossible  to  ascertain  from  the  dairy  inspection  records. 
There  are  only  two  dairies  offering  certified  milk,  and  they  do  it  on  a 
small  scale,  more  for  the  accommodation  of  their  customers  than  for 
profit.  One  of  the  dairies  produces  about  150  to  200  gallons  daily,  and 
the  other  one  less,  but  since  they  cater  to  both  St.  Paul  and  Minneapolis, 
it  is  not  possible  to  tell  just  how  much  of  the  whole  goes  to  St.  Paul. 

It  was  stated  by  the  Milk  Inspector  that  none  of  the  raw  milk  sold  is 
sold  in  loose  sales,  that  is  in  bulk,  not  bottled.  This  is,  of  course,  a 
great  advantage  and  is  one  factor  for  keeping  a  high  standard  in  the 
quality  of  milk.  Other  factors  conducive  to  a  characteristically  good 
milk  supply  are  those  previously  noted, — the  high  percentage  of  pasteur- 
ized milk,  the  comparatively  short  distances  from  which  milk  is  brought 
to  the  consumer,  and  the  large  proportion  of  time  in  the  year  in  which 
the  prevailingly  cool  temperature  is  favorable  for  keeping  milk  in  good 
condition.  In  view  of  these  considerations,  St.  Paul's  milk  supply  should 
be  quite  uniformly  good.  There  are  no  tabulations  kept  of  the  results  of 
dairy  scoring  and  the  bacteriological  examinations  but  for  the  purpose  of 
this  survey  we  have  tabulated  the  records  from  January  to  October  1918 
for  these  data,  with  the  following -results.  There  are  a  total  of  1,042 
producers  under  inspection,  311  inside  the  city  and  731  outside.  The 
scoring  during  this  time  has  been  negligible,  five  scores  made  in  January 
for  herds  containing  a  total  of  124  cattle  and  one  score  in  May  for  one 
herd  of  20  cattle.  The  results  of  these  few  scores  are  with  one  excep- 
tion fairly  good :  77,  26,  72,  73,  65,  and  77, — but  one  would  hardly  con- 
sider them  either  good  enough  or  numerous  enough  to  justify  absolute 
cessation  of  scoring  as  a  consequence. 

No  bacterial  counts  were  recorded  until  April,  and  the  bulk  of  those 
recorded  after  that  time  were  taken  in  August  and  September.  It  is 
very  evidently  a  good  policy  to  make  the  majority  of  counts  in  the  sum- 
mer months,  but  it  would  seem  that  July  at  least,  and  preferably  June 
also,  should  be  included  in  the  list  of  summer  months.  The  results  of 
what  examinations  were  made  are  as  follows : — 

Number  of  bacteria  per  cc. 

Under                        100,000  to                              500,000  to  Over 

100,000                      500,000                               1,000,000  1,000,000 

35                              23                                      11  2 

The  existing  City  ordinance  fixes  500,000  as  the  highest  number  of 
bacteria  per  cc.  allowed  in  milk  to  be  sold  as  pure.  Undoubtedly  this 
is  too  lenient  a  standard  and  it  is  to  be  hoped  that,  as  the  Dairy  Inspec- 
tor states,  there  will  soon  be  a  new  ordinance  with  a  more  satisfactory 
standard.     Interpreting  the  facts  in  the  light  of  the  present  standard, 

(49) 


however,  it  is  not  especially  gratifying  to  find  that  nearly  20%,  18.31% 
to  be  exact,  of  the  samples  examined  gave  higher  bacterial  counts  than 
500,000,  and  are  therefore  impure  milk  according  to  the  City  ordinance. 
The  situation  is  much  worse  if  we  take  a  more  generally  recognized 
standard  of  purity  for,  to  quote  from  the  New  Haven  Health  Survey 
"One  hundred  thousand  bacteria  per  c.  c.  is  the  maximum  number  of 
bacteria  permitted,  according  to  generally  accepted  standards,  in  milk  to 
be  drunk  raw,  while  1,000,000  is  the  maximum  number  generally  allowed 
for  milk  to  be  used  for  cooking."*  According  to  such  a  standard  a 
good  half,  or  50.70%  of  the  milk  examined  in  the  above  table  is  unfit 
for  raw  food.  Since  St.  Paul  has  no  classification  of  milk  to  be  sold  for 
raw  food  and  that  for  cooking  purposes,  it  is  reasonable  to  suppose  that 
a  part  at  least,  of  the  50.70%  unfit  for  raw  consumption  was  used  in 
just  that  way.  Of  course,  a  total  of  approximately  70  bacterial  exam- 
inations is  not  a  very  large  number  from  which  to  judge  the  quality  of 
a  city's  milk  supply,  also  altho  the  samples  tabulated  represent  all  the 
sources  of  supply  examined,  some  had  more  than  one  sample  taken  in 
the  given  time,  in  which  case  only  the  last  sample  was  tabulated.  If 
bacteriological  examinations  caused  improvement  in  those  cases,  it  is 
fortunate  for  the  character  of  the  milk  supply  that  we  have  tabulated 
the  final  samples;  also  it  would  seem  advisable  to  have  one  sample  at 
least  from  each  source  of  supply  to  know  whether  improvement  is  or 
is  not  necessary. 

Tuberculin  testing  is  done  by  the  Live  Stock  Inspector,  a  veteri- 
narian whose  title  is  misleading  since  his  work  is  mainly  in  the  field  of 
tuberculin  testing,  with  some  examinations  for  rabies,  and  his  records 
of  cattle  tested  are  on  the  Dairy  Inspection  cards.  From  January  to 
October,  1918,  there  were  2,816  cattle  tested,  of  which  51  responded  to 
the  test  and  were  condemned,  altho  only  28  of  those  51  were  killed. 
The  percentage  of  reactions  is  uncommonly  low,  about  4%,  and  it  may  be 
possible  as  Dr.  Young  states**  that  fraudulent  means  have  been  used  to 
defeat  the  purpose  of  the  test. 

The  State  has  a  Dairy  Inspection  Division  which  has  3  inspectors, 
one  of  whom  spends  most  of  his  time  in  St.  Paul.  He  takes  from  de- 
livery men  daily  samples  of  milk  which  are  analyzed  with  a  special  view 
to  upholding  the  State  standard  of  butter  fat  content.  Also  he  inspects 
dairy  barns  outside  of  city  limits,  and  scores  them  approximately  once 
a  year.  Here,  as  in  the  Food  and  Meat  Inspection  there  seems  to  be 
very  little  co-operation  between  the  State  and  City  inspections  and  there 
is  a  chance  at  least  for  duplication,  although  on  the  side  of  the  scoring 
it  has  been  seen  that  the  City's  scores  are  not  so  numerous  but  that  there 
is  a  chance  for  considerable  State  work  also. 

*Health  Survey  of  New  Haven,  p.  62. 
** Public   Health   Reports:   Jan.    12,    19,    1917.     Public   Health   Administration   in    St. 
Paul,  Minn.,  by  G.  B.  Young,  Surgeon  U.  S.  Public  Health  Service,  p.  103. 


(50) 


Sanitary  Inspection  of  Hotels  and  Restaurants 

Technically  speaking,  the  sanitary  inspection  of  hotels  and  restau- 
rants is  done  under  the  Division  of  Sanitary  Police,  altho  practically  the 
Hotel  Inspector  works  separately  and  in  a  more  or  less  independent 
capacity.  He  works  alone,  though  without  a  doubt  he  should  have  an 
assistant,  or  if  that  is  not  possible,  he  should  at  least  be  relieved  of  what 
office  work  he  is  now  called  upon  to  do  which  lies  outside  his  own  special 
field.  The  present  Hotel  Inspector  has  been  in  the  office  of  the  Health 
Bureau  for  four  years,  a  long  enough  time  to  enable  him  to  become 
fairly  familiar  with  the  workings  of  other  divisions  than  his  own, — 
with  the  result  that  he  is  frequently  pressed  into  service  in  work  entirely 
outside  his  own  field,  such  as  the  recording  of  vital  statistics,  and  how- 
ever clever  a  Jack-at-all-trades  he  may  be,  the  effect  of  such  procedure 
on  the  work  of  hotel  and  restaurant  inspection  can  not  fail  to  be  bad. 

The  work  of  hotel  and  restaurant  inspection  is  of  a  double  nature, 
for  since  licenses  are  granted  for  a  year  and  therefore  are  expiring  at 
all  times,  initial  inspection  for  granting  licenses  must  go  on  all  the  time, 
and  after  the  license  is  granted  the  place  must  be  inspected  and  scored 
from  time  to  time  to  insure  the  standard  to  be  maintained.  Because 
of  his  office  work  and  the  continuous  inspection  for  license  granting,  the 
Hotel  Inspector  states  that  he  is  not  able  to  do  very  much  work  in  scor- 
ing. When  he  does  do  anything  in  this  line  he  uses  a  score  card  of  his 
own  devising  which  evidently  answers  the  purpose  under  the  existing 
conditions.  If  the  Inspector  had  help  or  in  some  way  was  given  more 
time  to  do  the  work  of  scoring,  separate  score  cards  for  hotels  and 
restaurants  should  be  used,  and  these  cards  the  Inspector  in  the  light 
of  his  previous  experience  could  undoubtedly  formulate. 

The  Hotel  Inspector  was  unable  to  state  just  how  many  hotels  and 
restaurants  are  under  his  care  at  the  present  time,  and  because  of  pend- 
ing changes  in  the  system  he  preferred  not  to  have  us  study  the  files  for 
that  information  or  for  tabulations  of  the  scoring  and  its  results.  How- 
ever, he  said  that  in  other  years  he  had  about  600  hotels,  restaurants, 
etc.,  under  his  inspection,  but  that  the  number  was  considerably  smaller 
than  that  at  the  present  time.  The  falling  off  is,  of  course,  due  to  war 
conditions,  which  also  are  a  factor  to  be  considered  in  attempting  to 
enforce  the  highest  standards  of  hotel  inspection,  for  according  to  the 
Hotel  Inspector,  so  many  hotel  and  restaurant  keepers  are  on  the  verge 
of  having  to  close  up  shop  that  a  few  legal  requirements  more  or  less 
do  not  make  much  impression  on  them.  His  policy  is  one  of  education 
before  the  granting  of  a  license  rather  than  prosecution  afterwards,  and 
fortunately  the  routine  involved  in  the  filing  and  granting  of  an  appli- 
cation for  a  hotel  or  restaurant  license  is  conducive  to  the  success  of  this 
policy.  Before  a  formal  application  can  be  filed  the  premises  must  be 
inspected  by  the  Health,  Police  and  Fire  Departments,  at  which  time 

(51) 


it  is  a  very  simple  matter,  if  the  findings  are  not  satisfactory,  to  frankly 
tell  the  person  wishing  to  apply,  in  what  respects  he  falls  short  and  so 
help  him  to  raise  his  place  to  the  proper  standard  without  going  through 
the  red  tape  of  rejecting  his  formal  application  or  having  to  revoke  his 
license  later.  Licenses  are  granted,  when  approved  by  the  Council  after 
satisfactory  inspection  by  the  Health,  Police  and  Fire  Departments,  by 
the  License  Inspector,  and  he  is  the  official  to  whom  all  violations  of  the 
law,  i.  e.,  instances  of  hotels,  restaurants  and  all  other  like  places  operat- 
ing without  being  licensed,  are  reported.  However,  the  Health  Bureau 
can  revoke  any  hotel  or  restaurant  license  upon  the  grounds  of  unsatis- 
factory health  conditions,  as  can  the  Police  and  Fire  departments  for 
reasons  of  immorality  or  fire  risk.  But  as  has  just  been  explained,  on 
the  side  of  the  Health  Bureau  at  least,  the  policy  is  rather  to  educate 
before  granting  a  license  so  that  revocation  will  not  be  necessary. 

The  State  maintains  a  Department  of  Hotel  Inspection  through 
which  it  accomplishes  some  work  in  St.  Paul.  However,  here  as  in  the 
other  divisions  of  inspection — Meat,  Food  and  Dairy — there  is  a  regret- 
table lack  of  co-operation,  altho  the  blame  can  not  be  laid  on  the  in- 
spectors in  any  case,  since  there  is  the  handicap  of  lack  of  assistance  in 
both  City  and  State  work  due  to  inadequate  appropriation  of  funds. 
The  State  Inspector  and  his  deputy  have  5,000  hotels  to  inspect  through- 
out the  State.  In  consideration  of  the  amount  of  time  necessary  for 
traveling  and  the  inadequacy  of  funds  for  traveling  expenses,  ($900,  the 
sum  remaining  out  of  the  appropriation  of  $6,000.00  after  salaries  of 
Inspector,  Deputy,  and  stenographer,  and  postage  and  stationery  expendi- 
tures have  been  deducted,  must  pay  all  other  expenses,  including  those 
for  traveling)  it  is  not  surprising  that,  as  the  Inspector  states,  only  about 
a  third  of  the  hotels  in  the  State  are.  inspected  yearly.  Even  this  amount 
of  inspection  is  done  partly  by  the  125  inspectors  from  Oil,  and  Dairy 
and  Food  Inspection  Departments,  who  turn  over  appropriate  findings 
from  their  own  inspections  to  the  Hotel  Inspection  Division  whenever 
possible.  It  is  impossible  to  tell  how  many  inspectors  are  at  work  in  St. 
Paul,  or  how  many  inspections  are  made  by  them  in  this  City.  One  of 
the  aims  that  the  State  Inspector's  office  is  working  for  is  the  elimination 
of  the  cheap  lodging  house,  altho  it  realizes  that  something  better  must  be 
provided  to  take  the  place  of  the  cheap  lodging  house  before  it  can  be  abol- 
ished. The  office  of  the  State  Hotel  Inspector  is  also  interested  in  the 
development  of  hotels  on  the  cubicle  plan.  There  is  one  such  in  St.  Paul, 
on  Third  and  Robert  Streets,  which  seems  to  be  meeting  with  success 
not  only  from  the  sanitary  point  of  view,  but  from  the  financial  as  well. 

Both  the  City  and  State  Hotel  Inspectors  are  anticipating  changes 
in  their  departments  at  an  early  date,  and  it  is  to  be  hoped  that  their  antic- 
ipations will  be  realized  in  the  best  sense,  that  larger  appropriations 

(52) 


will  be  granted,  which  will  allow  more  assistance  and  more  time  for  co- 
operation with  each  other,  thus  bringing  about  a  high  standard  of  effic- 
iency all  around. 

The  Control  of  Communicable  Diseases 

As  was  stated  earlier  in  this  chapter  the  control  of  communicable 
diseases  is  directly  under  the  supervision  of  the  Deputy  Health  Officer. 
Until  quite  recently,  the  year  1914,  the  work  for  the  control  of  tuber- 
culosis was  done  by  an  organization  entirely  apart  from  the  City  Bureau, 
the  St.  Paul  Anti-Tuberculosis  Committee.  In  fact,  at  the  present  time, 
altho  the  Tuberculosis  Division  of  the  Bureau  of  Health  is  legally  under 
the  jurisdiction  of  the  City  Health  Bureau  and  responsible  to  it,  yet  the 
office  for  the  tuberculosis  work  is  situated  in  another  building  some  dis- 
tance from  the  one  in  which  the  Health  Bureau  is  located,  the  Tuber- 
culosis Dispensary  is  with  neither  the  Health  Bureau  office  nor  with  the 
rooms  of  the  Tuberculosis  Division,  and  furthermore  the  whole  routine 
work  of  the  Tuberculosis  Division  tends  to  form  a  somewhat  separate 
system — naturally  enough,  when  one  considers  its  growth  apart  from  the 
City  Health  Bureau  prior  to  its  being  taken  over  by  the  latter. 

In  view  of  this  somewhat  unique  relationship  of  the  control  of  tuber- 
culosis to  the  rest  of  the  communicable  disease  work,  we  shall  treat  it 
apart  and  give  it  fuller  discussion  later,  with  this  preliminary  explana- 
tion as  a  basis. 

MEDICAL  INSPECTORS  AND  SANITARY  INSPECTORS 

The  routine  work  for  the  other  communicable  diseases  is  performed 
by  Medical  Inspectors  and  Sanitary  Inspectors.  The  Medical  Inspectors 
are  four  in  number,  but  they  are  paid  for  part  time  only,  and  their  duties 
are  mainly  to  inspect  suspicious  cases  reported  to  the  Bureau  of  Health. 
If  such  cases  turn  out  to  be  cases  of  real  contagion  they  are  referred  by 
the  Medical  Inspectors  to  the  Sanitary  Inspectors  who  take  charge  of  all 
consequent  quarantine  routine.  The  Sanitary  Inspectors  are  12  in  num- 
ber, each  of  whom  has  charge  of  one  ward,  abating  nuisances  in  it  and 
looking  after  quarantine.  There  is  a  book  for  the  work  of  each  ward 
and  in  these  are  entered  all  sanitary  complaints,  most  of  which  are 
made  over  the  telephone,  and  all  requests  for  the  taking  of  cultures  and 
release  of  quarantine.  Each  Sanitary  Inspector  consults  his  book  twice 
a  day,  noting  after  the  various  cases  the  progress  of  his  work  on  them. 
He  also  makes  out  daily  reports  from  which  is  compiled  the  annual  re- 
port. Disinfection  is  in  the.  hands  of  the  Sanitary  Inspectors,  altho  the 
Health  Bureau  is  to  be  congratulated  on  its  policy  of  getting  away  from 
the  practice  of  disinfection  as  rapidly  as  possible  since  it  recognizes  that 
the  danger  of  contagion  is  not  so  much  in  the  surroundings  of  the  dis- 

(53) 


ease  as  in  personal  contact,  and  is  therefore  paying  more  attention  to 
the  isolation  of  patients  and  carriers. 

HOSPITALIZATION 

All  contagious  diseases  with  the  exception  of  small-pox  and  tuber- 
culosis are  cared  for  in  the  contagious  disease  wing  of  the  City  and 
County  Hospital.  The  City  and  Count)-  Hospital  holds  a  somewhat 
anomalous  position  in  the  health  organization  of  the  City,  inasmuch  as 
the  City's  part  of  its  support  is  in  the  hands- of  the  City  and  County 
Board  of  Control  and  not  the  Health  Bureau,  audio  the  latter  sends  its 
hospitalized  cases  of  contagious  diseases  there  and  has  some  general  con- 
trol in  that  line  such  as  the  ability  to  investigate  if  things  seem  not  to  be 
running  smoothly.  General  facts  concerning  the  City  Hospital  may  be 
found  in  the  discussion  of  all  the  hospitals  in  the  city.  It  will  suffice 
here  in  relation  to  the  worj<  of  the  Health  Bureau  in  communicable  dis- 
ease control  to  mention  that  all  cases  of  contagious  diseases  when  hos- 
pitalized are  sent  to  the  contagious  disease  wing  of  the  City  Hospital, 
with  the  exception  of  tuberculosis,  which  may  also  be  treated  at  the  City 
Hospital,  but  in  a  different  section,  the  Tuberculosis  Pavilion,  and  small- 
pox for  which  there  is  a  special  isolation  hospital  known  as  the  Dale 
Street  Infirmary.  As  in  the  case  of  the  City  and  County  Hospital,  the 
County  bears  part  of  the  expense  of  the  Dale  Street  Infirmary,  altho  in 
this  case  the  City's  share  is  charged  to  the  Bureau  of  Health,  the  peculiar- 
ity of  the  arrangement  being  that  while  the  Bureau  of  Health  bears  the 
expense  it  has  no  control  over  the  medical  attendance  which  is  performed 
by  the  City  and  County  Physician  who  is  responsible  only  to  the  Board  of 
Control.  There  is  a  Superintendent  in  charge  of  the  Infirmary,  and  his 
wife,  altho  not  a  registered  nurse,  acts  as  nurse  to  the  female  patients 
besides  being  housekeeper  and  cook.  There  is  also  an  assistant  whose 
official  title  is  that  of  Male  Nurse,  altho  actually  his  duties  are  those  of  a 
laborer  and  handy  man.  while  the  nursing  of  the  men  patients  is  per- 
formed bv  the  Superintendent.  In  1916  the  number  cared  for  in  the 
Dale  Street  Infirmary  was  96.  "Hospitalization  for  small-pox  is  not  com- 
pulsory in  St.  Paul,  and  for  that  same  year  there  were  33  cases  cared  for 
in  isolation  at  home.     There  were  no  deaths  in  either  case. 

THE  LABORATORY  OF  THE  HEALTH  BUREAU 

Bacteriological  work  for  the  control  of  communicable  diseases  is 
done  in  the  Bacteriological  Laboratory  controlled  by  the  Health  Bureau. 
The  laboratory  force,  as  was  stated  in  the  chapter  on  The  Organization 
of  the  Health  Bureau,  consists  of  the  bacteriologist,  laboratory  assist- 
ant, and  laboratory  helper.  A  record  of  the  examinations  made  is  com- 
piled every  month  and  published  in  the  monthly  bulletin,  while  all  the 
monthly  records  are  consolidated  into  the  tabulation  of  all  bacteriological 

(54) 


examinations  in  the  year  which  appears  in  the  annual  report.  The  fol- 
lowing Table  shows  the  amount  of  work  done  in  the  bacteriological  lab- 
oratory for  the  period  from  1910-1917:* 


Date 

Total 

Diph: 

Tuberculosis 

Wass. 

Blood 

Babies 

Misc. 

Milk 

Water 

Swim'g 

POS. 

NEC 

POS. 

NEC 

POS.  NEC 

Pool 

1910.. 

..15,358 

12,063 

342 

1,011 

353 

663 

11        10 

799 

58 

48 

1911.. 

..11,685 

8.452 

364 

1,036 

123 

403 

34      42 

752 

119 

360 

•  ■  • . 

1912.. 

..  8,427 

4,875 

356 

1.164 

126 

461 

43      35 

597 

649 

121 

1913.. 

..11,131 

8,297 

336 

1,031 

151 

510 

23      33 

193 

492 

65 

1014.. 

..19,541 

15,939 

389 

1,518 

131 

553 

1        9 

689 

643 

269 

•  •  •  • 

1915.. 

..17,891 

14.431 

336 

1,501 

132 

501 

6      13 

767 

47 

157 

1916....  17,065      12,905      310      1,327        39      407      46      44     1,282      410      154      141 
1917.... 23,301       18,904      288      1,306        26      363      36      35  (1,565)     642      136       .... 

Before  leaving  the  general  subject  of  communicable  disease  control 
something  should  be  said  regarding  measures  of  control  available  for 
epidemics.  At  the  time  of  writing  this  report  an  epidemic  of  Spanish 
Influenza  is  sweeping  the  whole  country,  and  altho  up  to  the  present  time 
St.  Paul  has  not  suffered  to  the  extent  of  some  other  cities,  the  compara- 
tive lightness  of  the  epidemic  here  has  been  due  to  good  fortune  rather 
than  to  pre-eminently  wise  measures  of  control.  Indeed,  instead  of  such 
a  comforting  situation  as  that,  there  are  certain  glaring  deficiencies  which 
need  only  a  greater  amount  of  devastation  from  this  or  any  other  epi- 
demic to  be  generally  acknowledged  as  criminal. 

In  the  first  place,  as  has  already  been  mentioned  earlier  in  this  chapter, 
the  only  hospital  over  which  the  City  has  control,  the  City  and  County 
Hospital,  not  only  is  entirely  outside  the  juriscjiction  of  the  Health  Bureau 
but  is  in  the  hands  of  the  Board  of  Controlfa  body  whose  reponsibility  is 
divided  between  the  City  and  County.  At  the  present  time  the  City  and 
County  Hospital  is  filled  to  capacity,,  and  the  Health  Bureau  upon  which 
the  responsibility  for  curbing  the  epidemic  rests,  is  powerless  to  provide 
further  hospitalization  with  the  present  facilities  at  its  disposal.  The  ob- 
vious compensation  for  lack  of  hospital  care  is  isolation  and  adequate 
nursing  in  the  home.  Without  doubt  .the  necessary  isolation  is  often  im- 
possible, especially  in  congested  areas  where  there  are  large  famlies  with 
two  or  three  persons  to  the  room.  What  can  be  done  in  regard  to  enforc- 
ing those  parts  of  the  recent  housing  legislation  concerned  with  the  restric- 
tion of  congestion  can  at  least  be  done  by  the  Health  Bureau,  altho  ade- 
quate enforcement  will  be  valueless  as  far  as  the  epidemic  is  concerned 
without  proper  provisions  for  the  immediate  amelioration  of  conditions 
of  congestion. 

In  regard  to  adequate  nursing  facilities  the  City  is  impotent.  With 
the  present  shortage  of  nurses  it  is  impossible  for  the  Health  Bureau  to 
requisition  a  temporary  nursing  force  to  meet  emergency  conditions,  and 
it  has  no  public  health  nurses  of  its  own,  barring  the  tuberculosis  nurses 

*The  totals  in  the  Table  for  the  years  1910,  1913,  and  1916  do  not  tally  with  those  in 
the  annual  health  reports  for  the  same  years,  since  it  was  found  that  the  latter  were 
not  a  correct  addition  of  the  specified  examinations.  The  rest  of  the  figures  are  exact 
copies  from,  the  annual  reports. 

(55) 


who  have  a  very  large  field  to  cover  in  their  own  work  and  are  not  sup- 
posed to  work  in  any  other  line.  Even  if  plenty  of  private  nurses  were 
available  for  emergency  work  the  Health  Bureau  would  be  unable  to  use 
them  or  other  medical  services  on  a  large  scale  without  special  appro- 
priation for  the  purpose,  while  without  a  permanent  staff  of  general 
public  health  nurses  in  its  own  department  it  could  not  even  perform  that 
limited  service  in  the  beginning  of  an  epidemic  which  might  so  have 
checked  its  growth  that  further  appropriation  and  extraordinary  mea- 
sures would  be  unnecessary. 

As  is  shown  in  the  chapter  on  health  work  in  the  public  schools,  the 
question  of  school  sanitary  control  of  contagious  diseases  rests  not  with 
the  Bureau  of  Health  but  with  the  Division  of  Hygiene,  Department  of 
Education.  Only  in  the  case  of  gross  neglect  on  the  part  of  the  latter 
can  the  Health  Bureau  step  in  and  take  more  than  an  advisory  control. 
Whatever  may  be  said  for  this  division  of  health  work  in  normal  times, 
during  the  exigencies  of  such  a  country-wide  epidemic  as  this  scourge  of 
Spanish  Influenza,  it  seems  unquestionably  a  regrettable  point  of  weak- 
ness to  allow  any  but  the  strongest  kind  of  centralized  control  in  public 
health  work. 

The  Control  of  Tuberculosis 

Explanation  of  the  unique  position  which  the  Tuberculosis  Division 
of  the  Bureau  of  Health  holds  in  respect  to  the  rest  of  the  Bureau  of 
Health  has  already  been  made  in  the  discussion  of  the  control  of  com- 
municable diseases  in  general.  The  working  force  of  the  Division  con- 
sists ordinarily  of  a  Head  Nurse  and  six  Visiting  Nurses,  one  Sanitary 
Inspector,  one  part-time  Medical  Inspector,  and  a  clerk  and  typist. 

The  Head  Nurse  does  not  have  a  district  but  has  her  time  fully  taken 
up  with  dispensary  work,  office  administration,  and  consultation  with  the 
head  of  the  Communicable  Disease  Division.  The  six  Visiting  Nurses 
are  each  assigned  to  a  district,  and  they  not  only  visit  to  acquire  data, 
give  instructions  and  follow  up  suspects,  but  also  do  beside  nursing  and 
dress  surgical  cases,  with  no  restrictions  on  the  admission  of  beneficiaries 
to  their  services,  giving  in  all  cases  advice  and  arranging  for  examination 
at  least.  The  nurses  are  not  uniformed  and  have  no  official  badge,  and 
no  other  title  than  that  of  Visiting  Nurse — a  condition  which  was  criti- 
cized by  Dr.  Young  in  his  survey  report,  but  in  spite  of  his  recommenda- 
tion that  they  be  called  "Field  Nurses  Bureau  of  Health"  and  wear  the 
City  uniform*  no  changes  along  this  line  have  occurred. 

In  the  year  1917  the  total  number  of  calls  made  by  the  nurses  was  15,- 
700  and  the  number  of  patients  they  succeeded  in  having  admitted  to 
sanatoria  or  other  institutions  was  322. 

The  Sanitary  and  part-time  Medical  Inspectors  form  one  of  the  more 
obvious  links  with  the  Bureau  of  Health,  since  they  are  primarily  offi- 

*Public  Health  Reports,  Jan.  12,  19,  1917.     Dr.  G.  B.  Young,  p.  133 

(56) 


cials  of  the  City  department  in  general  and  are  given  their  assignments  in 
the  specific  field  of  tuberculosis  control.  The  Sanitary  inspector's  work 
is  of  a  follow  up  nature,  inasmuch  as  he  sees  to  it  that  the  orders  made 
by  the  nurses  are  carried  out  in  respect  to  renovating  rooms  after  having 
been  occupied  by  tuberculosis  patients  and  to  burning  all  non-boilable 
things  used  by  and  around  patients.  In  the  year  1917,  360  such  renova- 
tions and  disinfections  were  accomplished.  The  part-time  Medical  In- 
spector works  at  the  dispensary  on  clinical  duties  alone.  He  holds  £wo 
morning  clinics  a  week  for  children  from  9  o'clock  on  as  long  as  there 
are  patients,  and  a  daily  clinic  from  12:30  on  for  adults.  As  has  been 
stated,  the  Head  Nurse  spends  a  large  part  of  her  time  with  the  clinical 
work  and  the  other  nurses  take  turns  in  helping  at  the  dispensary  also. 
As  in  the  case  of  the  home  nursing,  there  are  no  limitations  in  admitting 
patients.     All  who  come  are  given  at  least  an  initial  examination. 

The  report  for  the  dispensary  work  for  the  year  1917  is  as  follows: 

Total  Attendance   2,517 

New  examinations    632 

Revisits    1,885 

Positive   cases    181 

Observation  and  negative   451 

Positive   Cases 

Hospital  or  sanitorium  cases    127 

Died    14 

Tuberculosis  is  a  reportable  disease  in  the  State  of  Minnesota.  As 
is  the  case  in  most  communities,  however,  the  law  is  not  perfectly  carried 
out.  In  1917,  according  to  the  figures  in  the  annual  report  for  that  year 
a  third  of  the  total  339  fatal  cases  of  tuberculosis  were  first  reported 
by  the  death  certificate.  However,  out  of  the  113  cases  must  be  deducted 
the  30  caused  by  meningeal  and  the  13  by  miliary  tuberculosis,  making  a 
total  of  43  cases  where  since  the  disease  develops  as  a  sure  form  of 
tuberculosis  only  in  the  final  stage,  a  lack  of  reporting  other  than  by  death 
certificate  may  be  excused.  The  other  70  cases  were  chiefly  pulmonary 
and  it  seems  strange  indeed  that  they  were  not  seen  and  diagnosed  before 
death.  Besides  these  70  cases  or  20.6%  of  the  total  number  of  deaths 
from  tuberculosis  unreported  except  by  death  certificate,  there  were  107 
cases  duly  reported  but  reported  in  less  than  six  months  previous  to 
death  and  were  therefore  dying  cases  at  the  time  of  reporting.  Since 
one  of  the  essentials  in  tuberculosis  treatment  is  to  reach  the  patient  in 
the  earliest  stages  possible,  this  belated  reporting  may  fulfil  the  letter  of 
the  law  but  not  the  spirit,  and  likewise  does  it  fall  short  in  the  matter  of 
protection  to  others  since  such  neglect  is  capable  of  almost  incalculable 
harm  in  widening  the  chance  for  infection. 

The  above  quoted  figures  on  the  efficacy  of  the  reporting  system  speak 
for  themselves.  When  over  60%  of  the  total  number  of  deaths  in  a  year 
are  either  reported  only  by  the  death  certificate  or  reported  previously, 
but  so  very  nearly  at  the  time  of  death  that  the  cases  are  virtually  dying 
ones  at  the  time  of  registration,  it  is  evident  that  in  the  matter  of  satis- 

(57) 


factory  tuberculosis  reporting  St.  Paul  has  still  some  improvements  to 
make. 

That  the  Tuberculosis  Division  is  realizing  the  need  of  more  co-oper- 
ation from  the  physician  is  apparent  from  the  fact  that  in  the  year  1917 
there  was  started  the  practice  of  sending  Quarterly  Letters  to  physicians 
who  had  reported  cases  for  registrations  only.  On  account  of  depletion 
of  the  working  force  the  practice  has  had  to  be  discontinued  for  the  pres- 
ent. Information  concerning  the  results  obtained  from  such  letters  dur- 
ing the  year  1917  is  contained  in  the  following  quotation  from  the  report 
of  the  Tuberculosis  Division  in  the  Annual  Report  of  the  Bureau  of 
Health  for  that  year ; — 

"Following  the  procedure  in  other  cities,  Quarterly  Letters  were  sent 
to  physicians  who  had  reported  cases  for  registration  only.  They  were 
asked  the  following  questions :  Is  the  patient ~  reported  by  you  on  a 
given  date  still  under  your  care?  What  precautions,  if  any,  are  taken  to 
isolate  the  patient?  What  is  the  patient's  present  address?  One  hun- 
dred and  seventeen  letters  were  sent  concerning  301  cases.  One  hundred 
and  twenty-eight  were  reported  as  still  under  the  examining  physician's 
care,  16  had  died  out  of  town.  In  103  cases  physicians  reported  pre- 
cautions were  taken.  -"In  68  cases  the  doctors  did  not  know  the  patient's 
address.  In  104  cases  the  doctors  had  no  knowledge  of  the  patients  and 
47  were  reported  as  having  left  town.  This  report  is  interesting  as 
showing  that  in  50%  of  these  cases  the  doctors  did  not  remain  in  touch 
with  them.  As  they  were  not  visited  by  the  field  nurses,  #they  may  not 
have  been  supervised  at  all.  They  may  have  moved  and  infected  many 
others.  Their  own  families  may  have  been  the  victims  of  their  careless- 
ness. They  may  have  lost  all  chance  of  recovery  through  their  mode  of 
life.  It  seems  to  me  this  is  an  excellent  argument  for  allowing  the  field 
nurses'  cooperation." 

It  is  unnecessary  to  further  comment  upon  the  facts  revealed  by  the 
above  quotation.  It  is  to  be  hoped,  however,  that  the  practice  of  Quar- 
terly Letters  will  be  continued  and  that  it  will  be  used  not  only  for  investi- 
gation but  for  producing  increasingly  improved  conditions. 

The  Tuberculosis  Division  of  the  Bureau  of  Health  maintains  no 
sanitorium  or  other  hospital  facilities  of  its  own.  WTiat  institutional 
care  is  available  for  persons  afflicted  with  tuberculosis  is  either  under 
private  control,  or  where  public,  is  out  of  the  specific  jurisdiction  of  the 
Bureau  of  Health.  The  City  and  County  Hospital  has  a  separate  wing, 
the  Tuberculosis  Pavilion,  for  tuberculosis  patients.  All  other  hospitals 
in  the  city,  with  the  exception  of  one  small  one,  the  Midway  General,  ex- 
clude tuberculosis  cases.  A  City  and  County  Sanitorium  is  maintained 
at  Bass  Lake  several  miles  outside  the  city  limits,  and  the  Children's 
Preventorium  maintained  wholly  by  private  subscription,  is  situated 
on  land  adjacent  to  the  Sanitorium.  The  City  and  County  Sanitorium 
formerly  admitted  both  men  and  women,  but  the  present  regulations  pro- 
vide for  men  only  and  the  number  for  whose  care  there  are  adequate 

(58) 


facilities  is  twenty-four.     A  summary  of  the  work  accomplished  by  the 
City  and  County  Sanatorium  for  the  year  1917  is  as  follows:* 

Number  admitted  since  January  1,  1917   40 

Number  patients  remaining  in  Sanatorium  Jan.  1,  1917 18 

Total  number  of  patients  under  treatment  since  Jan.  1,  1917 58 

Number  patients  discharged  since  January  1,   1917 36 

Number  of  deaths  since  January  1,  1917 0 

Number  of  patients  remaining  under  treatment  December  31,   1917 22 

Total   58 

Discharged,    "Improved"     25 

Discharged,    "Unimproved"    11 

Died    0 

Remaining  under  treatment  December  31,  1917   22 

Total • 58 

Largest  number  of  patients  under  treatment  at  any  one  time 23 

Smallest  number  of  patients  under  treatment  at  any  one  time 17 

Daily  average  number  of  patients   20 

Daily  average  number  of  patients  and  employees    26 

Average  number  of  days'  stay  of  patients  128 

Total  number  of  day's  treatment  given  in  Sanatorium  since  January  1,  1917.  .7,427 

The  Children's  Preventorium  can  accommodate  45  children,  and  in 
view  of  the  size  of  its  waiting  list  an  enlargement  of  the  capacity  of 
this  institution  is  greatly  needed.  Further  discussion  of  the  work  of  the 
Preventorium  will  be  given  later  on  in  this  report  together  with  the  other 
charitably  run  agencies  devoted  to  health  work.  Besides  the  City  and 
County  Sanatorium  there  is  a  State  Sanatorium  in  Cass  County  near 
Walker,  Minnesota,  to  which  St.  Paul  is  entitled  to  send  a  certain  num- 
ber of  patients,  since  the  Sanatorium  is  open  not  only  to  those  counties 
having  no  sanatoria  of  their  own,  but  also  to  those  whose  sanatorium  ac- 
commodations are  insufficient  to  meet  local  needs.  There  is  no  allotment 
to  the  counties,  since  the  Sanatorium  has  always  had  enough  room  to 
take  all  the  patients  sent.  At  the  present  time,  Ramsey  County  has  58 
patients  there,  which  number  is  probably  not  the  maximum  allowed. 

Only  incipient  cases  are  admitted  to  the  State  Sanatorium,  however, 
so  that  the  advanced  cases  have  no  choice  but  the  City  and  County  Sana- 
torium or  the  City  and  County  Pavilion.  This  presents  an.  additional 
reason  for  the  prompt  reporting  of  cases  by  attending  physicians,  since 
delay  in  reporting  lessens  the  patients'  chances  for  admission  to  the  State 
Sanatorium. 

The  only  requirement  for  admission  to  any  of  these  institutions  is 
the  residence  of  the  patient  in  the  city  or  county  from  which  he  is  sent. 
The  cost  of  treatment  may  or  may  not  be  paid  by  the  patient,  depending 
entirely  upon  his  financial  circumstances.  Sanatoria  capacity  in  and 
about  St.  Paul  appears  to  be  adequate  for  the  city's  needs.  In  case  of  a 
temporary  shortage  patients  may  receive  treatment  in  any  of  the  other 
county  sanatoria  at  $10  a  week,  provided  that  none  of  that  county's  own 
residents  are  kept  on  the  waiting  list  for  that  reason.     Some  of  the  sana- 

*Taken  from  the  1917  Report  of  the  Board  of  Control  of   St.   Paul  and  Ramsey 
County,  Minnesota.  , 

(59) 


toria  in  other  counties*  are  more  attractively  equipped  than  those  on 
which  St.  Paul  depends  and  it  would  seem  that  the  latter  might  well  fol- 
low their  example  and  make  the  conditions  as  attractive  as  possible.  At 
present  the  City  and  County  Sanatorium  and  the  City  and  County  Pavil- 
ion are  not  popular,  and  altho  the  latter  cannot  get  rid  of  its  objectionable 
hospital  environment,  (objectionable  because  of  the  predisposition  of  the 
patient's  mind  against  a  hospital  which  is  considered  a  place  to  die  in) 
yet  at  least  a  certain  attractiveness  in  the  daily  routine  and  in  the  assign- 
ments of  work  might  be  introduced  in  both  these  institutions. 

Some  anti-tuberculosis  work,  one  fresh  air  class  for  25  pupils,  is  ac- 
complished in  the  schools  by  the  Division  of  Hygiene  in  the  Department 
of  Education,  which  should  be  mentioned  here,  but  will  be  more  fully 
discussed  later  with  the  other  school  health  work.  Additional  anti-tuber- 
culosis work  is  done  in  St.  Paul  by  two  other  agencies, — the  Minnesota 
Public  Health  Association,  and  the  State  Board  of  Health.  The  Min- 
nesota Public  Health  Association,  altho  spending  a  large  proportion  of 
its  effort  and  money  in  the  prevention  and  cure  of  tuberculosis,  works 
also  along  the  lines  of  more  general  public  health.  As  a  private  agency 
it  will  receive  more  detailed  discussion  further  on  in  this  report,  but  here 
in  connection  with  the  City  administration's  control  of  the  tuberculosis 
situation,  it  may  be  said  that  there  seems  to  be  considerable  lack  of  co- 
operation between  the  Minnesota  Public  Health  Association  and  the 
Tuberculosis  Division  of  the  Bureau  of  Health.  To  be  sure,  the  form- 
er's work,  in  St.  Paul  at  least,  tends  more  to  the  educational  side.  Also 
where  the  Minnesota  Public  Health  Association  encounters  cases  in  need 
of  service  in  St.  Paul  it  turns  them  over  to  the  City's  Division. 

The  same  criticism  holds  true  for  the  tuberculosis  work  of  the  State 
Board  of  Health.  With  the  exception  of  the  work  done  by  the  State  in 
the  reporting  of  cases  of  tuberculosis  belonging  to  the  City,  but  tempo- 
rarily outside  its  corporate  limits,  (this  forms  a  considerable  item  now 
because  of  soldiers  belonging  to  St.  Paul  but  quartered  outside)  the 
State's  main  attempts  at  co-operation  with  the  City  seem  to  be  spasmodic 
reporting  to  the  Tuberculosis  Division  of  cases  already  known  to  it,  cases 
sometimes  that  have  been  on  its  records  for  a  long  period  of  time.  One 
would  suppose  that  if  the  State  recognized  the  City's  Tuberculosis  Divi- 
sion as  such,  it  would  merely  refer  their  cases  of  tuberculosis  coming  to 
its  notice  to  the  Division  rather  than  following  up  the  cases  themselves. 
If  the  time  spent  on  such  details  were  turned  to  the  formation  of  a  pro- 
gram of  large  oversight  of  the  City's  work  and  leadership  in  the  latter' s 
constructive  policies,  tuberculosis  work  in  St.  Paul  would  attain  a  much 
higher  degree  of  efficiency. 

*A  good  example  of  what  can  be  done  in  the  way  of  making  a  sanatorium  attractive 
is  Nopeming  Sanatorium  in  St.  Louis  County,  Minn.  There  the  patients  are  not 
limited  in  their  work  to  the  house  drudgery  of  the  care  of  the  institution,  for  altho 
they  do  perform  the  household  duties  as  in  other  sanatoria,  they  also  have  classes  in 
modeling,  basketry,  etc.,  by  which  they  are  not  only  kept  happy,  but  are  given  a  certain 
amount  of  vocational  training  as  well. 

(60) 


Infant  Welfare  Work 

The  City  Health  Bureau  has  no  department  for  the  prevention  of 
infant  mortality,  and  the  work  it  does  in  that  line  is  negligible.  Beyond 
the  work  of  the  stenographer  in  checking  up  births  and  deaths  of  chil- 
dren under  two  years,  and  the  Table  in  the  annual  report  showing  the 
deaths  of  infants  under  one  year  arranged  according  to  wards  there  is  no 
especial  work  done  by  the  cit3^  in  the  extraordinarily  important  field  of 
infant  mortality  prevention.  Very  fortunately  for  the  babies  of  St.  Paul 
they  are  not  entirely  dependent  upon  the  city  for  help  to  good  health, 
since  a  privately  maintained  organization,  The  Baby  Welfare  Associa- 
tion, fills  this  need. 

A  matter  that  is  likely  to  have  a  strong  bearing  on  the  infant  mortal- 
ity rate  of  any  city  is  the  prevalence  of  midwifery  and  the  amount  of 
government  supervision  exercised  over  this  practice.  St.  Paul  seems  to 
have  the  basis  for  a  goodly  problem  in  this  respect.  The  annual  report 
for  1916  was  the  first  to  show  any  figures  concerning  midwifery,  there- 
fore comparisons  are  possible  for  only  the  two  years  1916  and  1917. 
The  following  tables  show  the  percentages  of  births  attended  by  mid- 
wives  in  these  two  years  and  their  distribution  by  wards. 

The  distribution  varies  largely  in  the  different  wards, — from  16,  or 
4.52%  of  the  total  births  in  the  Seventh  Ward  to  283,  or  40.93%  in  the 
Eighth,  for  the  year  1916,  and  from  8,  or  2.21%  in  the  Seventh  Ward  to 
256,  or  39.09%  in  the  Eighth  for  the  year  1917.  The  number  of  births 
in  all  the  wards  attended  by  midwives  is  very  nearly  a  quarter  of  the 
total  births  in  the  city— 24.78%  for  1916,  and  22.37%  for  1917.  Wheth- 
er the  slight  decrease  from  1916  to  1917  is  due  to  changing  conditions  or 
to  normal  variability  it  is  impossible  to  say  without  statistics  for  other 
years  for  comparisons. 

Table  XXIII 

Table  Showing  the  Distribution  of  Births  in  St.  Paul  by  Attendant  and 

by  Wards  for  ipi6. 

WARDS             PHYSICIAN  MIDWIFE             OTHER  TOTAL 

No.  Cases         %       No.  Cases  %       No.  Cases     %  No.  Cases         % 

1 448  69.47  196  30.38  1  .15  645  100.00 

II 391  81.77  85  17.81  2  .42  478  100.00 

III 103  73.05  38  26.95  0  .00  141  100.00 

IV 106  91.37  10  8.63      "     0  .00  116  100.00 

V 377  61.98  230  37.86  1  .16  608  100.00 

VI   417  73.33  150  26.32  2  .35  569  100.00 

VII 339  95.48  16  4.52  0  .00  355  100.00 

VIII 407  58.94  2&3  40.93  1  .14  691  100.00 

IX 285  72.71  107  27.29  0  .00  392  100.00 

X 437  92.75  33  7.04  1  .21  471  100.00 

XI 397  92.22  34  7.78  0  .00  431  100.00 

XII 233  66.18  119  33.82  0  .00  352  100.00 

Total   3,940  75.06  1,301  24.78  8  .15  5,249  100.00 

(61)    • 


Table  XXIV 

Table  Showing  the  Distribution  of  Births  in  St.  Paul  by  Attendant  and 

by  Wards  for  ipiy. 

WARDS             PHYSICIAN  MIDWIFE             OTHER  TOTAL 

No.  Cases  %       No.  Cases  %       No.  Cases     %  No.  Cases        % 

1 424  70.90  172  28.77  2  .33  598  100.00 

II 418  85.31  72  14.69  0  .0  490  100.00 

III 73  71.57  29  28.43  0  0  102  100.00 

IV 79  90.81  8  9.19  0  0  87  100.00 

V 406  66.02  208  33.82  1  .16  615  100.00 

VI 399  76.00  123  23.43  3  .57  525  100.00 

VII 355  97.79  8  2.21  0  0  363  100.00 

VIII 398  60  76  256  39.09  1  .15  655  100.00 

IX ...309  74.28  106  25.48  1  .24  416  100.00 

X 462  93.52  31  6.28  1  .20  494  100.00 

XI 410  92.76  32  7.24  0  0  442  100.00 

XII 253  70.28  106  29.44  1  .28  360  100.00 

Total          ....3,986  77.44  1,151  22.37  10  .19  5,147  100.00 

There  are  no  records  of  the  midwives  in  the  City  Bureau  of  Health, 
which  lack  makes  it  impossible  to  state  even  approximately  the  number 
practicing  in  the  city.  The  above  figures,  however,  show  that  the  num- 
ber is  not  negligible  since  nearly  one-fourth  of  the  births  reported  for 
1916  and  1917  were  attended  by  midwives. 

Supervision  of  midwives  is  entirely  in  the  hands  of  the  State,  the 
City  having  no  record  of  examination  or  registrations.  The  State  re- 
quires either  a  certificate  from  a  recognized  school  of  midwifery,  or,  if 
that  is  lacking,  an  examination  by  the  board  of  examiners.  Upon  com- 
pliance with  the  requirements  of  qualification  licenses  for  one  year  only 
are  granted  upon  the  payment  of  a  fee  of  one  dollar. 

The  Recording  of  Vital  Statistics 

The  Bureau  of  Health  maintains  a  statistician  for  the  collection  and 
recording  of  vital  statistics.  His  duties  are  to  copy  records  of  births 
and  deaths  and  to  issue  copies  of  the  same,  and  also  to  issue  burial  per- 
mits. The  statistician  is  not  specially  trained  for  his  position,  which 
seems  unfortunate  indeed,  inasmuch  as  such  work  is  supposed  generally 
to  require  considerable  technical  knowledge  and  since  the  presence  of 
errors,  especially  in  the  mortality  returns,  even  if  few  in  number,  mark- 
edly detracts  from  their  value.  The  same  lack  of  special  training  is 
found  in  the  case  of  the  stenographer  who  checks  up  deaths  from  hos- 
pitals and  births  and  deaths  of  children  under  two  years,  and  prepares 
the  death  certificates  for  sending  to  the  State  Board  of  Health,  which 
last  duty  especially  requires  a  technically  trained  person  if  freedom  from 
error  is  to  be  the  standard  sought.  The  original  certificates  are  sent 
to  the  State,  copies  being  made  and  kept  in  the  City  Bureau's  office. 
They  pass  technical  inspection  at  the  hands  of  the  Deputy  Health  Officer, 
and  judging  from  the  omissions  and  incomplete  information  in  the  re- 
quired social  data,  he  very  evidently  confines  his  labors  to  inspection  of 

(62) 


purely  medical  data.  At  the  same  time  that  the  copies  are  made  the  rec- 
ords of  deaths  are  also  transferred  to  cards  and  filed  alphabetically,  or 
ostensibly  so,  as  a  matter  of  fact,  since  the  file  may  be  used  by  any  one 
with  no  one  person  directly  in  charge,  it  seems  to  be  in  chronic  state  of 
disorder,  and  is  therefore  as  much  a  source  of  irritation  as  of  use,  to  an 
outsider  at  least;  perhaps  the  members  of  the  office  force  have  become 
accustomed  enough  to  it  to  be  indifferent.  Such  lack  of  system  very 
obviously  detracts  from  the  efficiency  of  statistical  work  and  should  not 
be  allowed  to  contine.  Furthermore,  it  would  greatly  facilitate  the  use 
of  the  data  acquired  in  the  division  of  vital  statistics  to  typewrite  the 
copies  of  the  certificates,  and  to  use  adding  machines  or  other  mechanical 
means  for  computing  the  results  of  the  returns.  At  present  the  copying 
is  done  by  hand  and  no  mechanical  aids  are  used  in  the  arithmetical  work. 
The  birth  certificates  are  also  copied,  the  originals  sent  to  the  State  and 
the  copies  bound  as  in  the  case  of  the  death  certificates.  But  unfortu- 
nately no  card  index  is  kept  of  the  births,  and  it  is  therefore  a  very  labor- 
ious proceeding  to  find  the  record  of  any  particular  birth,  since  unless  the 
data  is  accurately  known,  hundreds  or  even  thousands,  of  the  forms  may 
have  to  be  gone  through. 

The  data  on  the  death  certificates  is  used  for  checking  in  all  com- 
municable diseases,  and  as  a  basis  for  epidemiological  investigations,  es- 
pecially in  typhoid  fever.  There  are  weekly  tabulations  made  accord- 
ing to  wards  which  are  not  published,  the  published  report  being  the 
monthly  bulletin  containing  tables  and  classifications  of  deaths,  births, 
communicable  diseases,  and  bacteriological  examinations.  The  final  re- 
port is  the  annual  one  in  which  the  following  information  concerning 
vital  statistics  is  given : 

Causes  of  deaths  by  months  according  to  International  Classification  of  Diseases. 

Table  of  deaths  by  months  according  to  nativity,  age,  color,  sex  and  social  relation. 

Table  of  deaths  by  wards  according  to  sex,  color,  age  and  residence  with  addition  of 
deaths  due  to  premature  births  and  of  still  births. 

Table  of  births  by  months  according  to  sex,  color,  and  nativity  of  parents. 

Table  of  births  by  wards  according  to  sex,  color,  nativity  of  parents  and  attendant  at 
birth. 

Table  of  births  and  deaths  for  last  ten  years. 

Table  of  comparative  population,  number  of  deaths  and  death  rates  for  last  five  years. 

Tables  of  cases  of  reportable  disease  (diphtheria,  scarlet  fever,  small-pox,  typhoid 
fever,  measles,  tuberculosis,  poliomyelitis  and  whooping  cough)  by  months  accord- 
ing to  wards. 

It- may  be  readily  seen  from  the  foregoing  list  that  altho  in  most  re- 
spects the  statistical  data  is  satisfactorily  full  yet  there  are  a  few  things 
lacking.  There  are  no  birth  rates  given,  no  infant  mortality  rates,  and 
no  death  rates  for  principal  diseases — without  which  information  no  re- 
port of  vital" statistics  could  be  considered  absolutely  complete.  Also 
while  St.  Paul  is  to  be  congratulated  on  having  data  in  mortality  sta- 
tistics compiled  according  to  ward,  sex,  age,  and  color,  two  other  im- 
portant correlations  are  neglected,  namely — deaths  according  to  ward 
and  nativity,  and  according  to  ward  and  cause. 

(63) 


Medical  Work  of  the  City  and  County  Board  of  Conrol 

The  medical  service  performed  by  the  Board  of  Control  of  St.  Paul 
and  Ramsey  County  falls  into  three  divisions — that  of  the  City  and 
County  Hospital,  which  is  discussed  at  length  under  the  general  classifi- 
cation of  Hospital  Facilities,  the  work  of  the  City  and  County  Physi- 
cians, and  the  Free  Dental  service  of  the  City  and  County. 

The  City  and  County  Physicians  are  three  in  number, — a  Chief  whp 
is  also  Superintendent  of  the  City  and  County  Hospital  and  two  assist- 
ants. Their  work,  other  than  that  performed  by  the  Chief  as  Superin- 
tendent of  the  City  and  County  Hospital,  is  the  provision  of  medical 
service  for  all  those  cared  for  by  the  City  and  County  because  of  want, 
contagious  diseases  (small-pox  or  tuberculosis)  or  criminality.  Accord- 
ing to  the  annual  report  of  the  Board  of  Control  for  1917  their  work 
for  the  needy  in  St.  Paul  and  Ramsey  County  comprised  the  following : 

City  Calls    2,978 

Office    consultations     9,248 

Visits  to  Ramsey  County  Poor  Farm . .  44 

The  contagious  disease  work  of  the  City  and  County  physicians  is 
confined  to  professional  visits  to  the  Dale  Street  Infirmary  (small-pox 
hospital)  and  the  City  and  County  Sanatorium,  (tuberculosis  hospital). 
In  the  1917  report  of  the  Board  of  Control,  18  visits  were  reported  to 
the  latter  institution  and  19  to  the  former.  More  detailed  discussion  of 
the  work  of  the  City  and  County  Sanatorium  has  already  been  made 
under  the  larger  heading  of  Tuberculosis  Control  in  St.  Paul. 

The  penal  institutions  which  depend  upon  the  City  and  County  Phy- 
sicians for  medical  service  are  the  Workhouse,  County  Jail,  and  Central 
Police  Station.  No  regular  medical  examination  of  the  inmates  is  made 
at  the  time  of  their  detention,  but  one  of  the  physicians  is  called  when- 
ever needed.  At  the  workhouse  there  has  just  been  instituted  a  special 
attempt  at  venereal  disease  treatment  which  is  described  more  fully  under 
the  chapter  on  Venereal  Diseases,  but  the  work  has  not  been  carried  on 
for  a  long  enough  period  of  time  for  a  definite  report  of  results  ac- 
complished. 

The  Free  Dental  service  of  the  City  and  County  is  maintained  by  the 
Board  of  Control  at  the  St.  Paul  Free  Dispensary.  In  1917  there  were 
two  dentists  whose  work  for  the  year  was  as  follows  : 

Examinations 1,916 

Prophylactic    treatments     1,748 

Instructions 1,737 

Pulps    removed    220 

Root   Canal    fillings    269 

Cement   fillings    212 

Alloy   fillings 685 

Copper  cement  fillings    383 

Treatments    1,705 

(64) 


Anaesthetics: 

General     1,056 

Local  469 

Extractions: 

Permanent   807 

Deciduous    2,798 

Total   14,005 

There  were  during  the  }^ear  1917,  1,386  new  and  2,031  old  patients, 
making  a  total  of  3,417. 

Venereal  Diseases 

The  City  Health  Bureau  has  no  organized  work  for  the  prevention 
or  cure  of  venereal  disease,  the  most  that  it  does  being  the  payment  for 
the  services  of  a  physician  engaged  in  venereal  disease  work  at  the  Work- 
house. This  work  has  been  in  progress  such  a  short  time, — since  June 
I,  1918,  that  it  is  not  yet  in  good  working  order.  The  plan  is  that  all 
men  and  women  arrested  and  held  for  court  sentence  for  reasons  in- 
volving public  morals,  shall  be  examined  for  the  presence  of  venereal  dis- 
ease before  being  taken  before  the  judge  for  sentence.  There  are  no 
clinics  held  at  the  Workhouse,  but  merely  hospital  accommodation  for 
those  inmates  having  venereal  disease.  At  present,  however,  the  hos- 
pital ward  is  not  being  used,  since  there  is  no  nurse  provided  to  be  in 
charge  of  it.  It  is  expected  that  this  deficiency  will  be  remedied  in  a 
short  time  however.  Also  there  is  a  possibility  that  a  night  matron  will 
be  installed.  The  ward  has  accommodations  for  1 5  patients  but  up  to 
this  time  all  patients  have  been  cared  for  in  the  cells.  The  women  have 
been  treated  by  the  matron  to  the  best  of  her  ability  altho  she  is  not  a 
trained  nurse.  Such  care  as  is  necessary  for  the  men  patients  is  given 
by  the  City  and  County  Physician.  The  length  of  stay  at  the  workhouse 
for  treatment  depends  on  the  individual  case,  but  averages  about  thirty 
days. 

From  the  beginning  of  the  work  in  June  1918  to  December  31,  1918 
there  were  treated  at  the  Workhouse  38  cases  of  venereal  disease.  28 
of  these  were  cases  of  gonorrhea,  20  of  which  were  women,  9  were  of 
syphilis,  8  of  which  were  women,  and  in  1  case  a  woman  was  infected 
with  both  gonorrhea  and  syphilis. 

At  the  present  time  there  are  being  treated  at  the  Workhouse  8  fe- 
males and  5  males,  which  includes  2  males  not  sent  there  for  treatment 
but  found  upon  examination  to  have  the  disease. 

Other  work  of  a  more  general  nature  for  the  cure  and  prevention  of 
venereal  diseases  is  carried  on  entirely  separately  from  municipal  admin- 
istration, being  under  the  auspices  of  the  State  Board  of  Health,  the 
United  Charities,  and  the  Wilder  Charity  Nurses.  Further  discussion 
of  this  work  is  given  in  relation  to  the  whole  health  program  of  the  Unit- 
ed Charities. 

(65) 


Mental  Hygiene 

The  only  provision  made  by  the  City  for  work  in  Mental  Hygiene  is 
the  employment  by  the  Department  of  Education  of  a  specialist  in  mental 
testing.  Her  work  is  primarily  the  testing  of  school  children  in  which 
respect  she  is  employed  in'the  capacity  of  Supervisor  of  Special  Classes, 
but  her  services  are  available  also  for  the  Juvenile  Court,  the  State  Board 
of  Control,  the  Probate  Court,  the  District  Court,  charitable  organiza- 
tions and  private  individuals.  Such  cases  are  referred  to  her  as  Psychol- 
ogist of  the  Psycho  Medical  Clinic  held  three  times  a  week,  Monday  and 
Wednesday  afternoons  and  Saturday  mornings. 

All  cases  found  subnormal  are  reported  to  the  State  Board  of  Con- 
trol. The  mental  tester  has  no  authority  to  compel  institutional  care,  or 
in  fact  any  kind  of  treatment,  but  she  makes  suitable  recommendations 
and  urges  their  acceptance.  There  naturally  is  little  chance  for  follow- 
up  work  in  anything  but  the  school  work,  since  her  first  duty  is  to  the 
latter.  In  the  school  work,  however,  more  strict  account  is  kept  of  the 
cases.  Every  year  the  mental  tester  makes  a  survey  of  the  schools  where- 
by she  picks  out  all  the  children  retarded  two  years  or  more,  except  those 
for  whose  retardation  there  is  a  legitimate  excuse  such  a  recent  arrival  in 
this  country  and  ignorance  of  the  language,  and  examines  them  for  men- 
tal abnormality.  Those  which  show  such  abnormality  are  placed  in  spec- 
ial classes,  of  which  there  are  five  for  exceptional  children,  one  for  deaf, 
and  six  for  children  with  defective  speech.  The  total  number  of  cases 
tested  and  assigned  to  these  classes  from  June  1917  to  June  1918  was 
289. 

Educational  Work 

In  the  spring  of  1917  a  Health  Week  was  held  under  the  auspices  of 
the  St.  Paul  Association.  The  Bureau  of  Health  paid  for  a  director  of 
the  Week  and  was  one  of  the  exhibitors.  Other  exhibitors  were  the  City 
and  County  Hospital,  State  Hospital  for  Crippled  Children,  St.  Paul 
Baby  Welfare  Association,  St.  Paul  Free  Medical  Dispensary,  Dental 
Exhibits  by  the  St.  Paul  District  Dental  Society  and  United  Charities, 
Department  of  Public  Works,  Open  Air  Class  Room  by  Board  of  Edu- 
cation and  United  Charities,  School  Nurses,  Public  Library,  Neighbor- 
hood House,  Children's  Preventorium,  Playgrounds  Department,  Uni- 
versity of  Minnesota  Farm  School,  Home  Economics  and  Dairy  Depart- 
ments, State  Bureau  of  Labor  and  Industries,  Department  of  Weights 
and  Measures. 

St.  Paul  can  also  boast  of  a  Baby  Week  held  in  the  same  year — 1917 
— altho  not  under  the  auspices  of  the  Health  Department  either,  but  un- 
der those  of  a  private  organization,  the  Baby  Welfare  Association. 

On  the  whole  what  educational  health  work  is  done  by  the  city  seems 
to  be  of  a  routine  nature  rather  than  that  of  propaganda,  the  initiative  of 
which  at  least  it  leaves  to  outside  organizations,  altho  being  very  ready 
with  its  approval  and  assistance. 

(66) 


Health  Budget 

In  the  year  1917  the  total  expenditure  incurred  by  the  Bureau  of 
Health  was  $93,217.93.  This  includes  salaries  and  expenses  paid  for  the 
public  baths,  the  public  comfort  station,  and  the  dog  pound.  Without 
the  expenditures  for  these  three  divisions  the  total  sum  was  $61,715.42, 
making  a  per  capita  cost  of  24.4  cents  for  a  budget  unquestionably  of  a 
health  nature.  That  this  is  very  much  too  low  a  per  capita  allowance  is 
obvious  to  any  one  at  all  conversant  with  public  health  affairs.  Accord- 
ing to  the  authors  of  the  New  Haven  Health  Survey,  "It  is  generally 
recognized  that  between  40  and  50  cents  per  capita  is  essential  for  the 
maintenance  of  a  thoroughly  efficient  health  department.  The  Commit- 
tee on  Organizations  and  Functions  of  Municipal  Health  Departments 
of  the  American  Public  Health  Association  recommends  45  cents  as  a 
standard."*  The  amount  per  capita  spent  on  the  conservation  of  health 
in  other  cities  of  approximately  the  same  population  as  St.  Paul  is  given 
below.  The  figures  are  for  the  year  1915  and  taken  directly  from  the 
United  States  Census  publication.** 


City 


Per  Cap.  Cost  of 
Health  Conservation 


City 


Per  Cap.  Cost  of 
Health  Conservation 


New  Bedford,  Mass 0.68 

Hartford,    Conn 0.68 

Cambridge,  Mass 0.66 

Providence,  R.  1 0.61 

Fall  River,  Mass 0.58 

Seattle,  Wash 0.53 

Springfield,  Mass 0.52 

Louisville,   Ky 0.51 

Syracuse,  N.  Y 0.49 

Worcester,    Mass 0.47 

Lawrence,  Mass 0.44 

Grand  Rapids,  Mich 0.44 

Washington,  D.   C 0.43 

Memphis,  Tenn 0.40 

Trenton,  N.  J 0.35 

Bridgeport,  Conn 0.35 

Salt  Lake  City,  Utah 0.34 

Nashville,  Tenn 0.33 

Albany,    N.   Y 0.33 

Waterburv,   Conn 0.32 

Omaha,    Neb 0.31 

New  Haven,   Conn 0.30 

Minneapolis,  Minn 0.29 


Rochester,  N.  Y 0.28 

Oakland,   Cal 0.28 

Denver,  Colo 0.28 

Butte,  Mont 0.27 

Paterson,  N.  J 0.26 

St.    Paul,   Minn 0.25 

Columbus,    O 0.25 

Spokane,  Wash 0.23 

Lowell,  Mass 0.21 

Indianapolis,   Ind 0.21 

Akron,  0 0.21 

Tacoma,   Wash 0.19 

Portland,    Ore 0.18 

Kansas   City,   Kans 0.09 

Jersey   City,    N.   J 0.18 

Toledo,    O 0.17 

Reading,  Pa 0.16 

Dayton,    O 0.16 

Wilmington,    Del 0.14 

Camden,    N.    J 0.13 

Scranton,    Pa 0.12 

Kansas   City,    Kans 0.09 

Youngstown,  0 0.08 


Fourteen  cities  out  of  the  total  forty-five  other  than  St.  Paul  spend 
less  than  25  cents  per  capita.  Of  the  other  thirty-one  cities  spending 
more  than  that  amount,  fourteen — Washington,  Seattle,  Providence, 
Louisville,  Worcester,  Syracuse,  Memphis,  Fall  River,  Grand  Rapids, 
New  Bedford,  Cambridge,  Hartford,  Springfield,  and  Lawrence — spend 
the  required  40  to  50  cents  or  more  per  capita. 

Some  changes  of  recent  date  have  been  made  in  the  salary  schedule 

*Health  Survey  of  New  Haven,  p.  94. 
**Bureau  of  the  Census,  Bulletin  132,  p.  68. 

(67) 


of  the  employes  of  the  Health  Bureau  in  St.  Paul  through  a  civil  service 
ordinance  effective  Feb.  4,  1919,  and  these  changes  bring  up  the  per 
capita  cost  to  30  cents  for  health  protection  exclusive  of  expenditures  for 
Harriet  Island  public  baths,  the  comfort  station,  and  the  dog  pound. 
The  salaries  of  the  employes  of  the  Health  Bureau  proper  as  they  stand 
at  the  present  time  are  as  follows : 

Health  Officer  $  4,000.00 

Deputy    Health    Officer .' 2,500.00 

Junior  and  Senior  Stenographer,  720-780,  now  getting      720.00 
Senior   Clerk    (statistician)    1,020-1.260,   now   getting..     1,260 

Typist  Clerk,  1,020-1,260,  now  getting 1,080.00 

General  Bookkeeper    1,440.00 

Laboratory  Assistant,  1,140-1,500  (none  at  present) 

Laboratory  Helper,  480-600,  now  getting   480.00 

Chief  Dairy  Inspector    1,740.00 

2  Assistant  Dairy  Inspectors,  each  1,380.00 

Live  Stock  Inspector  V.  S 1,620.00 

Laborer  Assistant  V.  S.,  for  3  months,  day 2.80 

Chief    Sanitary   Inspector 1,740.00 

14  Sanitary  Inspectors,  1st  yr.  100,  2nd  105,  3rd  110, 

4th  115/ 

1   Italian    1,260.00 

1    Italian 1,320.00 

12  including  Hotel  Inspector  and  TB  Sanitary 

Inspector,  each    1,380.00 

Food  Inspector,  1,200-1,500,  now  getting 1,500.00 

3  Meat  Inspectors 

1  Meat  Inspector  getting 1,500.00 

2  Meat  Inspectors  getting,  each 1,320.00 

5  Part  Time  Medical  Inspectors  (including  1  for  TB.) 

1,260-1,500. 

2  Medical  Inspectors  getting  each 1,260.00 

3  Medical  Inspectors  getting  each    1,320.00 

Chaff eur,  900-1,200,  none  at  present 

Supt.  Dale  Street  Infirmary   600.00 

Nurse  Dale  Street  Infirmary,  600-750,  now  getting..  750.00 

Yardman  Dale  Street  Infirmary 600.00 

Nurse  in  charge  of  Tb.  Div.,  1,260-1,620,  now  getting  1,620.00 

6  Nurses  Tb.  Division,  1,020-1,260,  now  getting,  each  1,140.00 

Bacteriologist,  1,820-2,100,  now  getting 2,100.00 

Senior  Clerk  Stenographer   Tb.  Div.   1,020-1,260,  now 

getting    1,080.00 

Matron  Tb.  Div.,  600-780,  now  getting 780.00 

To  the  list  of  salary  expenditures  must  be  added  an  amount  to  cover 
incidentals  and  running  expenses  which  in  1917  amounted  to  $11,306.74. 
Using  that  figure  as  a  basis  if  we  add  $12,000  to  the  present  salary  cost 
it  gives  a  total  of  $79,211.60,  or  a  per  capita  expenditure  of  30  cents. 

A  number  of  additions  to  the  above  listed  working  force  should  be 
made  and  they  are  as  follows  : 

1     Laboratory  Assistant  (Making  a  total  of  2) 

1  Statistician  (Making  a  total  of  1) 

2  Dairy  Inspectors    (Making  a  total  of  4) 

6     Sanitary  Inspectors    (one   for   hotel   inspection   especially,    making  a   total 

of  20) 
1     Food  Inspector   (Making  a  total  of  2) 
4    Nurses   Tb.  Div.    (Making  a  total  of   10) 
Full  time  Medical  Inspection  (Making  a  total  of  4) 

(68) 


For  salaries  of  the  above  the  schedule  now  in  use  would  of  course  be 
used,  with  the  exception  of  the  Statistician  and  the  full  time  Medical  In- 
spection for  which  there  is  no  provision.  A  trained  statistician  should 
be  employed  at  a  salary  of  $1,800.00  to  relieve  the  Senior  Clerk  of  the 
statistical  duties  for  which  he  is  not  trained.  For  medical  inspection  only 
4  men  need  be  employed  but  they  should  be  required  to  give  full  time  at 
a  salary  of  $2,500  each  or  $10,000  for  the  whole  of  the  medical  inspec- 
tion work.  Taking  the  above  addition  in  salaries  and  those  now  employ- 
ed at  their  maximum  since  in  a  short  time  they  will  have  automatically 
reached  the  maximum,  the  total  expenditures  for  salaries  would  be  $92,- 
031.60,  an  excess  over  that  at  the  present  time  of  $24,820.00.  Adding 
to  the  proposed  expenditure  $12,000  to  cover  running  expenses,  the  total 
would  be  $104,031.60  or  a  per  capita  expenditure  of  40  cents.  It  should 
be  observed  that  the  proposed  changes  would  bring  St.  Paul  barely  within 
the  list  of  cities  spending  the  required  amount  of  40  to  50  cents  per 
capita,  altho  it  falls  slightly  below  the  45  cents  which  is  the  recognized 
standard  of  the  Committee  on  Organizations  and  Functions  of  Municipal 
Health  Departments  of  the  American  Public  Flealth  Association. 

Sanitary  Supervision  of  Schools 

The  city's  instrument  for  carrying  on  its  health  work  in  the  public 
schools  is  not  the  Health  Bureau,  but  the  Division  of  Hygiene,  Department 
of  Education.  Whether  or  not  this  is  a  fortunate  placement  of  school 
health  work  depends  largely  upon  the  amount  of  co-operation  between  the 
Division  of  Hygiene  in  the  Department  of  Education  and  the  Health  Bu- 
reau, Department  of  Public  Safety.  Health  work  in  the  hands  of  the  De- 
partment of  Education  gains  on  the  one  hand  in  logical  and  intimate  con- 
nection with  the  schools,  but  loses  on  the  other  in  the  strength  that  one 
central  control  over  all  public  health  matters,  school  and  otherwise,  would 
bring.  What  is  lacking  in  centralization  may  possibly  be  compensated 
for  by  co-operation  between  the  two  departments,  but  there  is  one  defi- 
ciency in  the  workings  of  school  hygiene  under  the  Department  of  Educa- 
tion that  can  not  be  remedied  in  such  a  manner, — that  is,  the  lack  of 
authority  of  the  Department  of  Education  to  reach  the  parochial  and 
private  schools.  There  are  in  the  city  40  parochial  and  private  schools 
with  an  enrollment  of  9,546  pupils  of  school  age;  if  children  over  sixteen 
years  of  age  were  included  the  figure  would  be  somewhat  larger.  The 
public  school  enrollment  for  last  year  was  30,572,  making  a  total  of  40,- 
118  children  attending  school  in  St.  Paul.  This  means  that  a  fairly  high 
proportion  of  school  children,  23.79%  of  the  total  40,118,  are  outside  of 
the  jurisdiction  of  the  city's  school  health  work,  and  get  the  benefit  of  it 
only  as  the  parochial  and  private  schools  voluntarily  co-operate,  as  they 
do  in  the  case  of  epidemics  and  a  certain  amount  of  educational  health 
work  (Oral  Hygiene  lectures,  etc.) 

(69) 


The  aim  and  specific  objects  of  the  Division  of  Hygiene  are  concisely 
stated  in  a  set  of  rules  and  regulations  drawn  up  for  the  benefit  of  the 
working  force  and  are  quoted  here : 

"The  aim  of  the  Division  of  Hygiene  is  to  assist  in  obtaining  the 
maximum  of  efficiency  in  the  educational  system  with  the  conservation  of 
good  health.  The  method  is  educational  rather  than  operative;  how  to 
prevent  and  protect,  and  not  the  treatment  of  the  disease. 

The  specific  objects  are: 

1.  The  control   of  sanitary  and  hygienic  conditions   in  the   schools. 

2.  Detection  and  correction  of  physical  defects. 

3.  The  discovery  and  treatment  of  cases  of  mental  deficiency. 

4.  The  detection  and  exclusion  of  parasitic  and  contagious  diseases. 

5.  The  bringing  to  the  homes  and  the  parents  the  knowledge  of  child  hygiene. 

6.  Making  possible  to  obtain  the  maximum  of  efficiency  in  the  educational 
system  with  the  conservation  of  good  health." 

The  working  force  of  the  Division  of  Hygiene  normally  consists  of 
1  medical  inspector  who  is  Director  of  the  Division  and  directly  respon- 
sible for  its  conduct  to  the  Superintendent  of  Schools;  1  chief  nurse,  13 
school  nurses,  1  supervisor  of  special  classes  and  an  office  secretary.  All 
the  employes  have  been  under  civil  service  examination  since  1914.  At 
present  some  of  the  force  are  left-overs  from  the  old  regime,  since  there 
have  been  but  4  vacancies  occurring  since  1914  and  filled  by  civil  service 
examination,  those  of  Chief  School  Nurse,  Medical  Inspector  and  two 
school  nurses.  The  Medical  Inspector  is  a  part-time  employe,  paid  by  the 
hour  for  not  more  than  15  hours  a  week,  altho  he  must  be  within  reach  of 
the  Division  at  any  time.  His  duties  according  to  the  above  mentioned 
statement  of  rules  and  regulations  are  to  examine  all  children  referred  to 
him  by  teachers  or  nurses  as  cases  of  contagious  diseases,  all  children  who 
have  been  absent  for  illness,  or  for  any  indefinite  or  unassigned  cause, 
all  children  returning  after  a  previous  exclusion,  all  children  (except 
those  excused  because  of  objections  of  parents)  who  are  suspected  of 
physical  and  mental  defects,  and,  whenever  ordered  by  the  Supervisor  of 
Hygiene,  to  make  complete  physical  examinations  of  each  child  unless 
such  child  is  properly  excused,  and  to  record  the  results  on  the  physical 
record  card  of  the  child.  Furthermore,  he  has  general  duties  in  inspect- 
ing from  time  to  time,  the  general  condition  of  the  school  buildings  from 
the  point  of  view  of  sanitation,  and  making  a  report  of  his  findings  to  the 
Supervisor  of  Hygiene. 

The  duties  of  the  Chief  Nurse  may  be  quoted  directly  from  the  rules 
and  regulations  drawn  up  by  the  Division  and  are  as  follows : 

"The  Senior  Nurse  shall  be  responsible  directly  to  the  Director  of  Hy- 
giene. She  shall  see  that  his  instructions  and  orders  are  properly  carried  out 
by  the  school  nurses.  Her  duties  shall  be  to  supervise  the  school  work  of 
the  nurses ;  see  that  the  'Instructions  to  School  Nurses'  are  complied  with ; 
inspect  the  daily  reports,  make  a  consolidated  monthly  report  of  the  work; 
keep  up  the  map  for  contagious  diseases  and  card  file  for  individual  schools ; 
see  that  the  follow-up  work  of  the  school  nurse  is  properly  conducted  and 
obtain  reports  from  the  Free  Dispensary  and  other  sources  of  checking  the 

(70) 


follow-up  work.  During  the  existence  of  an  epidemic  in  a  school,  she  shall 
visit  the  regular  nurse  frequently  and  consult  with  her  concerning  the  control 
of  the  epidemic." 

"She  shall  see  that  a  school  nurse  is  at  the  school  when  the  Medical  In- 
spector is  working  and  that  the  school  nurse  co-operates  with  and  carries 
out  the  instructions  of  the  medical  Inspector.  She  shall  see  that  the  proper 
physical  records  are  made  and  inform  the  office  of  the  Director  of  Hygiene 
when  the  services  of  a  Medical  Inspector  are  required." 

The  school  nurses  are  on  duty  from  8 :45  A.  M.  to  5  :00  P.  M.  except 
on  Saturday  when  the  hours  are  from  8:45  A.  M.  to  12:00  M.  They 
average  three  schools  a  day,  two  in  the  morning  and  one  in  the  afternoon. 
Besides  routine  examinations  and  consultations  with  teachers  and  par- 
ents, the  nurses  do  as  much  home  visiting  as  they  have  time  for,  and  such 
follow-up  work  as  is  necessary,  particularly  in  the  way  of  taking  children 
to  the  hospital  or  dispensary.  Daily  written  reports  are  made  by  the 
nurses  to  the  Division  of  Hygiene,  and  in  the  case  of  infectious  and  quar- 
antinable  diseases  the  nurses  must  report  immediately  by  telephone  to  the 
office  of  the  Division. 

The  Supervisor  of  Special  Classes  has  under  her  charge  the  classes 
for  Subnormals,  Defective  Speech  Classes,  Class  for  Deaf,  Open  Air 
School,  Boys'  Farm  and  Girls'  Home. 

The  duties  of  the  Office  Secretary,  besides  the  office  routine  of  cor- 
respondence, telephone  calls,  filing  of  requisitions,  etc.,  are  to  report 
cases  of  contagious  diseases  to  the  Health  Bureau,  to  notify  the  various 
schools  of  reports  from  the  Health  Bureau,  and  to  make  appointments 
for  mental  tests  and  to  keep  the  records  of  the  same. 

The  working  force  of  the  Division  of  Hygiene  has  met  with  quite 
a  number  of  changes  during  the  last  year  owing  to  the  exigencies  of  war. 
In  May,  1917,  the  Director  of  Hygiene  obtained  a  leave  of  absence  for 
war  work  and  until  the  beginning  of  the  school  year  in  1918  his  place 
was  not  permanently  and  satisfactorily  filled.  The  Division  was 
to  have  been  allowed  two  part:time  medical  inspectors  last  year, 
but  since,  owing  to  the  present  shortage  of  medical  men,  only  one  report- 
ed for  the  civil  service,  the  examination  was  postponed  and  a  temporary 
appointment  was  made  for  part-time  work,  but  his  resignation  in  May 
again  forced  a  temporary  appointment  in  the  Division  with  which  to 
finish  the  year.  In  spite  of  so  much  re-adjustment  there  was  a  satisfac- 
tory amount  of  work  done,  for  not  only  did  the  Medical  Inspector  ex- 
amine all  special  cases  sent  to  him  by  the  nurses,  and  the  boys  in  athletics 
in  three  of  the  High  Schools,  but  he  made  a  systematic  examination  of 
every  child  in  one  of  the  schools,  the  Lincoln,  in  co-operation  with  the 
newly  established  Health  Center  of  the  Wilder  Charity  in  that  district, 
and  examined  every  child  in  the  special  classes.  A  number  of  nurses' 
places  also  had  to  be  refilled  because  of  resignations  for  war  work,  but 
in  spite  of  the  consequent  confusion  there  was  in  1917-1918  a  gratifying 
increase  in  work  over  that  done  the  year  before,  as  the  following  report 
shows : 

(71) 


WORK  DONE  BY  NURSES  IN  1916-1917 

The  following  tabulation  shows  the  work  done  by  the  Nurses  during 

the  fiscal  year  1916-1917. 

5,475  visits  were  made  to  schools. 

7,270  home  visits  were  made,  217  of  which  were  for  cases  of  truancy. 
243,299  pupils  seen  by  the  nurses  for  various  reasons. 
18,441  physical  examinations  were  made. 

17.496  examinations  for  pediculosis. 

66.497  miscellaneous  examinations  were  made  including  class  room  examinations  for 

contagious  diseases. 
919  parents  consulted  the  school  nurse. 
17,456  parents  notified. 
8,048  children  excluded  from  school,  10,729  readmitted. 

701  referred  to  charitable  organizations. 
16.580  cases  of  communicable  disease  were  found  in  the  schools. 
2,718  were  found  in  homes. 

8,048  children  excluded  on  account  of  contagion. 
3,678  cases  reported  to  Health  Bureau  for  quarantine. 
22,545  treatments  given  in  schools.     Most  of  these  children  would  otherwise  have  been 
excluded. 

WORK  DONE  BY  NURSES  IN  1917-1918 
The  following  tabulation  shows  the  work  done  by  the  Nurses  during 

the  fiscal  year  1917-1918. 

6,246  visits  were  made  to  schools. 

6.884  home  visits  were  made,  146  of  which  were  for  cases  of  truancy. 
2957787  pupils  were  seen  by  the  nurses  for  various  reasons. 

23.498  physical  examinations  were  made. 
24,907  examinations  for  pediculosis. 

165,397  miscellaneous  examinations  were  made  including  class  room  examinations  for 
contagious  diseases. 
1,182  parents  consulted  the  school  nurses. 
7,429  children  excluded  from  school,  12,758  readmitted. 

179  families  referred  to  charitable  organizations. 
2,020  cases  of  communicable  diseases  were  found  in  the  homes. 
7,345  children  excluded  from  school  on  account  of  contagion. 
3,080  cases  reported  to  the  Health  Bureau  for  quarantine. 
.24,943  treatments  given  in  schools.     Most  of  these  children  would  otherwise  have  been 
excluded. 

There  were  an  unusually  large  number  of  cases  of  contagious  dis- 
eases in  the  schools  during  the  year  1917-1918,  the  total  percentage  for 
each  disease  being  as  follows : 

Disease                                                     No.  % 

Diphtheria     264  .86 

Scarlet  Fever   352  1.14 

Measles 199  .64 

Pertussis    796  2.60 

Small-pox    134  .43 

Chicken-pox    396  1.29 

Mumps 1.12  .36 

Rubella  (Liberty  Measles)   1294  4.23 

For  the  year  1916-1917  we  have  been  able  to  acquire  data  on  conta- 
gion in  the  schools  of  five  other  cities  of  approximately  the  same  size  as 
St.  Paul,  in  consequence  of  which  the  following  Table  has  been  made : 

St.  Paul  stands  third  in  the  list  of  six  cities  in  its  percentage  of  all 
the  diseases,  and  so  far  as  the  diseases  taken  individually  are  concerned 
it  seems  to  show  fairly  normal  conditions. 

(72) 


> 

X 

w 

m 
<! 
H 


O 

Co 


CO 


e*5    ^ 


Cl 


^ 


•SO 


•<s> 

c^ 


CO 


^ 


gsS 


n    oi    bO 

flj  c  c 


6 


N    ^ 


S    6 
w  53 


•5   ^ 


Ph 


^ 


<u     o 
§    53 


00 

"3- 

NO 

ON 

00 

r^ 

LO 

CN 

K 

§ 

vo 

On 

eg 

NO 

00 

VO 

eg 

CO 

o 

CM 

00 

r-H  CM  t-H 


e^ 

CO 

ON 

«  sd 

o 

NO 

i-  > 

ca  «j 

CO 

o 
53 

ON 

NO 
CO 

.2 

^ 

o 

lO 

V 

JZ 

J3 

Oh 

o 

C} 

in 

s 

53 

CM 

s 

N.  fc 


o 

ON 

CO 

O 

CM 
00 

oo 
o 

°o~ 

no" 

CM 

CM 

tF 

CM 

en     ' 

c  : 

Uh 

<u  . 

O 

> 

C?   rr 

On     . 

rt 

*o    • 

O    nj 

oH 

(U    g 

c 

tJ'O 

o 

ffi 

2 

53 

pm 

E     -P   G 


0. 

i. 

cu 

O 

i 

rt 

U 

£ 

03) 


In  the  following  Table  is  given  for  1917-1918  the  number  of  children 
for  whose  treatment  the  school  nurses  have  been  either  directly  or  in- 
directly responsible: 

Dental    Work    11,091 

Medical   treatment 407 

Surgical    treatment    105 

Eyes   treated    1,683 

Nose  and  throat  1,103 

Ears    treated 103 

Skin    treated    52 

Orthopedic    11 

Children's   Dept 5 

Miscellaneous 150 

Below  are  given  the  number  of  visits  made  during  1917-1918  to  the 
St.  Paul  Free  Dispensary  by  school  children  referred  there  by  the  school 
nurses : 

Eye    Department    1,505 

Dental  Department   2,050 

Nose    and    Throat    492 

Skin    Department    302 

Children's  Department  348 

Orthopedic    Department    29 

Surgical    Department    70 

Medical  Department  , 25 

Ear    Department    47 

Dental  hygiene  campaigns  have  been  a  normal  feature  of  school 
medical  work  since  the  school  year  1915-16,  altho  the  work  was  tempo- 
rarily dropped  last  year.  The  last  dental  hygiene  campaign,  that  of  the 
year  1916-17  was  very  successful.  There  were  appropriate  motion  pic- 
tures and  lectures  by  ten  different  dentists.  There  was  cause  for  con- 
gratulation for  the  co-operation  not  only  of  the  public  school  nurses, 
but  of  the  parochial  schools  as  well. 

There  are  at  present  two  school  dental  clinics,  which  were  started 
originally  by  private  organizations  and  taken  over  by  the  City  in  Novem- 
ber, 1917.  Their  work  has  gone  on  successfully  in  spite  of  the  lack  of  a 
dental  hygiene  campaign,  as  can  be  readily  seen  from  the  following : 

EDISON  SCHOOL  CLINIC 

Permanent  Fillings : 

Amalgam    220 

Cement 90 

Gutta  percha   35 

Deciduous    fillings     12 

Extractions 54 

Treatments     61 

Cleanings    83 

Appointments    474 

Thirty-six  hours  given  for  instruction  in  oral  hygiene  and  use  of 
tooth  brush. 

(74) 


CLEVELAND  SCHOOL  CLINIC 

Permanent  Fillings : 

Amalgam    ; 547 

Cement    63 

Gutta  percha   35 

Lead   9 

Extractions : 

Deciduous     319 

Permanent     1 

Treatments     133 

Examinations  and  cleanings    . . . . 197 

Appointments    715 

Besides  the  purely  medical  work  in  the  nurses  daily  routine  there  are 
nurses'  meetings  and  lectures,  with  occasional  educational  expeditions  to 
outside  institutions  such  as  the  University  Hospital  in  Minneapolis,  and 
the  State  Hospital  for  Crippled  Children  at  Phalen  Park,  St.  Paul.  Also 
the  nurses  are  at  times  called  upon  to  do  some  educational  work  them- 
selves outside  of  strictly  school  routine,  as  is  indicated  by  the  fact  that 
for  the  last  two  years  a  six  weeks'  course  has  been  conducted  in  co-opera- 
tion with  the  City  and  County  Hospital  whereby  student  nurses  are  en- 
abled to  go  with  the  school  nurses  on  their  rounds  and  so  get  consider- 
able practical  experience  in  school  health  work.  Some  of  the  nurses 
from  the  Minnesota  Public  Health  Association  have  also  availed  them- 
selves of  the  same  privilege,  and  in  the  spring  of  1918  nurses  taking  the 
University  of  Minnesota  Extension  course  in  Social  Service  organized 
by  the  Wilder  Charity,  Department  of  Social  Service,  put  in  part  of 
their  volunteer  field  work  with  the  school  nurses  on  their  rounds. 

As  to  the  educational  part  of  school  work  proper,  there  are  various 
classes  such  as  those  for  Little  Mother's  clubs,  Personal  Hygiene  and 
First  Aid  which  are  a  success  but  could  be  further  developed.  Also 
there  are  special  classes  which  lie  fully  as  much  in  the  field  of  hygiene  as 
in  that  of  pedagogy, — one  Fresh  Air  Class,  one  class  for  the  deaf,  six 
defective  speech  classes  and  four  classes  for  the  subnormal.  In  the  Fresh 
Air  Class  particularly,  success  depends  largely  on  building  up  the  children 
physically  before  attempting  to  reach  a  high  educational  standard,  and 
the  same  is  true  in  varying  degrees  for  the  "ungraded  room"  found  in 
ten  of  the  schools  which  are  for  backward  children  and  not  for  mental 
or  other  kinds  of  defectives,  and  which  receive  merely  the  regulation 
health  supervision  of  all  the  schools. 

A  final  word  before  finishing  the  discussion  of  the  Division  of  Hy- 
giene and  its  efficiency  must  be  said  regarding  the  accommodations  and 
equipment  given  to  the  school  nurses.  There  has  undoubtedly  been  a 
sad  lack  in  this  respect,  and  there  still  is  much  to  be  done  altho  some- 
thing at  least  has  been  accomplished  during  this  last  year  when  one  of 
the  schools  fitted  up  a  very  comfortable  room  especially  for  the  nurse, 
several  other  schools  provided  new  desks  for  the  nurses,  and  two  schools 
put  in  extension  telephones  for  the  nurse's  convenience.  But  even  with 
these  improvements  the  conditions  at  present  are  such  that  while  in  22 

(75) 


schools  the  nurses  have  a  room  in  which  to  work,  in  4  schools  they  work 
in  cloakrooms,  in  16  schools  in  the  halls,  in  8  in  the  classrooms,  in  1  in 
the  library,  in  2  in  the  principal's  office  and  in  3  they  have  basement 
rooms.  It  surely  is  unnecessary  to  dwell  upon  the  loss  in  efficiency 
which  must  result  from  such  unsystematic  arrangements.  As  soon  as 
possible  suitable  rooms  should  be  put  at  the  disposal  of  the  school  nurses, 
should  be  properly  equipped  and  supplied  with  telephones,  preferably  of 
the  extension  variety  to  connect  with  each  of  the  rooms  as  well  as  with 
the  outside. 

In  regard  to  data  on  the  sanitation  of  school  buildings  we  are  for- 
tunate in  having  at  hand  the  "Report  of  a  Survey  of  the  School  System 
of  St.  Paul,  Minnesota"  which  appeared  in  print  in  the  spring  of  1918, 
and  which  contains  more  complete  information  on  the  sanitary  condi- 
tions of  school  buildings  than  would  be  feasible  to  attempt  to  acquire 
for  this  health  survey,  information  which,  because  of  the  recent  date  of 
the  above  mentioned  publication  is  as  up-to-date  as  is  necessary  for  prac- 
tical purposes.  Part  of  the  Survey  work  was  done  by  the  school  nurses, 
and  a  general  summary  of  their  findings  as  given  by  the  Survey  Report 
is  listed  below,  supplemented  by  similar  findings  of  the  school  nurses  in 
their  regular  sanitary  survey  of  1917-18. 

1.  28  schools  reported  the  feather  dusters  as  being  used. 

(The   number   of    schools   using   feather   dusters   was    found   to   have  been   re- 
reduced  to  8  in  1917-18). 
The  practice  of  using  the  feather  duster  cannot  be  too  strongly  condemned. 

2.  The  most  efficacious  method  of  disinfecting  is  the  cleaning  of  the  desks,  floors  and 

toilets  with  a  standard  disinfecting  agent.     This  is  far  superior  to  fumigation. 

3.  13  schools  were  reported  as  not  opening  the  windows  during  recess.     In  previous 

years  there  were  rules  that  required  all  windows  to  be  opened  during  recess  and 
other  stated  periods.  (The  nurses  in  1917-18  found  14  schools  guilty  of  not 
opening   windows    at   recess). 

4.  13  schools  reported  as  having  glossy  blackboards. 

(The  number  increased  to  14  in  1917-1918) . 

5.  28  schools  reported  as  having  the  temperature  of  the  room  above  the  maximum 

(In  the  survey  of  1917-18  there  were  found  17  schools  which  had  temperatures 
of  rooms  either  above  "or  below  the  normal). 

6.  7  schools  were  reported  as  having  rooms  with  insufficient  light.     (This  number 

was  found  reduced  to  2  in  the  survey  of  1917-18). 

7.  Opaque  shades  are  still  used  in  forty-three  schools.     (There  has  been  a  big  drop 

in  this  number  in  1917-18,  from  43  to  23). 

8.  17  schools  were  reported  with  walls  too  dark.     (Only  8  schools  now  have  walls 

too  dark). 

9.  No  effort  to  adjust  the  seats  to  pupils  was  reported  in  13  schools. 

10.  Unsatisfactory    cloakrooms    were    reported    in    14    schools.     (Same    condition    in 

1917-18). 

11.  13  schools  were  not  provided  with  ventilating  screens.     (The  number  of  schools 

without  ventilating  screens  is  now  8). 

12.  Only  9  schools  were  provided  with  soap,  water  and  towels.     (There  are  now  24 

schools  having  provision  for  soap,  water  and  towels). 

13.  20  schools  were  reported  without  sanitary  drinking  fountains,  and  in  two  schools 

the  common  drinking  cup  was  found.  (The  number  has  now  been  reduced  to 
11). 

14.  Provision  is  made  in  the  entire  63  schools   for  only  1,228  children  to   obtain  a 

drink  of  water  at  the  same  time.  _  In  8  of  the  schools  only  1  child  can  obtain 
a  drink  at  a  time. 

The  rest  of  the  sanitary  findings  of  the  School  Survey  may  be  given 
under  their  proper  headings,  used  in  the  report,  Toilet  Facilities  in  Ele- 

(76) 


mentary.  Schools,  Water  Supply,  Heating  and  Ventilating  Systems,  and 
Lighting  of  Classrooms,  abstracts  of  which  findings  follow  in  their  re- 
spective places. 

TOILET  FACILITIES  IN  ELEMENTARY  SCHOOLS* 

In  addition  to  the  larger  part  of  the  equipment  generally  placed  in 
the  basement  or  ground  floor,  each  other  floor  should  be  provided  with 
emergency  toilets.  Separate  toilets  should  be  provided  for  kindergarten 
children  and  placed  in  a  room  adjacent  to  the  kindergarten  room. 
Offices,  teachers'  rooms,  auditoriums,  gymnasiums,  dressing  rooms  and 
janitors'  quarters  should  be  equipped  with  toilet  conveniences. 

Adequate  provision  of  toilet  facilities  requires  one  seat  for  each  25 
boys,  one  urinal  stall  for  20  boys  and  one  seat  for  each  15  girls. 

The  types  of  fixtures  installed  in  the  St.  Paul  schools  are  in  general 
satisfactory. 

Lavatories  are  insufficient  in  number  and  useless  because  no  paper 
toweling,  soap,  or  hot  water  are  provided. 

Toilet  paper  is  dispensed  from  a  single  roller,  which  at  the  rest  hour 
is  entirely  insufficient. 

Table  XXVI. 
Showing  Sufficiency  of  Toilet  Accommodations.** 

Per  cent.  Boys'  toilet  Boys'  Girls'  toilet 

of  sufficiency  seats  Urinals  seats 

21-30     0  2  0 

31-40  1  0  0 

41-50  0  1  1 

51-60  0  3  1 

61-70    ..5  4  3 

71-80    7  4  6 

81-90    6  8  4 

91-100    3  8  7 

101-125     10  7  13 

126-150     9  8  11     :... 

151-200 4  6  4 

Over  200  7  1  2 

Standard  of  sufficiency — 

1  toilet  each  25  boys.  1  toilet  each  15  girls.         1  urinals  each  20  boys. 

With  a  few  exceptions  toilet  rooms  are  clean  and  as  well  kept  as  con- 
ditions of  location  will  permit. 

Ventilation  by  means  of  the  windows  is  the  only  method  possible  in 
toilet  rooms  and  this  is  not  resorted  to  in  cold  weather.  As  a  result,  the 
air  from  the  toilets  penetrates  to  all  parts  of  the  building.  In  some  in- 
stances it  is  actually  forced  into  classrooms  by  fans. 

WATER  SUPPLY*** 

1.     Drinking  facilities. 

St.  Paul's  schools  are  very  poorly  equipped  with  drinking  fountains. 

In  many  of  the  buildings  no  drinking  facilities  of  any  kind  are  provided. 

*  Abstract  of  Findings  in  the  .School  Survey  Report. 
**Table  from  Survey  Report,  p.  119. 
*** Abstract  of  findings  in  the  School  Survey  Report. 

(77) 


At  common  wash  basin  faucets  in  the  toilet  rooms,  either  individual 
cups  owned  by  students  are  generously  passed  around  or  children  drink 
by  placing  heads  in  the  wash  bowls  with  their  mouths  over  the  faucet. 

It  will  be  noted  that  in  11  buildings  housing  4,371  children,  or  17.6% 
of  the  entire  enrollment,  no  drinking  facilities  are  provided.  This  is  a 
condition  unparalleled  in  any  city  comparable  with  St.  Paul  from  which 
similar  data  are  available. 

Table  XXVII. 

Showing  Comparison  of  the  Drinking  Facilities  of  St.  Paul  Elementary 

Schools  with  those  of  Salt  Lake  City  and  Denver* 

No.  of  ST.  PAXIL  SALT  LAKE  DENVER 

Children  per  No.  of  Per  cent  No.  of  Per  cent  No.  of  Per  cent 

Fountain  Bldgs.  of  Bldgs.  Bldgs.  of  Bldgs.  Bldgs.  of  Bldgs. 

Less  than  25  0  0  2  6.6  3  6.2 

50  to  49  ***    9  16.6  3  10.0  12  22.2 

50  to  74  9  16.6  11  36.6  22  40.6 

75  to  99  3  62  9  30.0  5  9.2 

100  to  124  5  9.2  3  10.0  2  3.6 

125  to  149  1  1.8  0  0.0  5  9.2 

150  or  over    .....15  27.7  2  6.6  5  9.2 

No.  of  buildings  with 

no  drinking  fountains   .12  22.2  0  0.0  0  0.0 

Per  cent  of   children 

without  drinking 

fountains    17.6**  .00  .00 

Per  cent  of  bldgs., 

standard  or  above...         33.2**  53.2**  69.0** 

Per  cent  of  buildings 

below    standard....         67.1**  46.6**  31.2** 

In  buildings  in  which  drinking  fountains  have  been  more  or  less  ade- 
quately supplied  the  selection  has  not  been  wise,  nor  the  location  satis- 
factory. The  type  of  fountain  most  commonly  found  is  one  from  which 
a  child  can  scarcely  drink  without  touching  his  lips  to  the  outlet.  The 
fountains  are  frequently  located  in  the  toilet  rooms  of  the  basement  with- 
out regard  to  the  convenience  of  the  children,  or  other  potent  considera- 
tions. Toilet  rooms  at  their  best  are  not  fit  places  for  drinking  fountains. 
Apparently  no  standard  has  been  recognized  in  determining  the  number  of 
pupils  per  fountain.  There  should  be  a  jet  for  about  50  pupils.  They 
should  also  be  graduated  in  height. 

II.  WASHING  AND  BATHING 

Almost  without  exception  the  number  of  wash  bowls  in  St.  Paul's 
school  buildings  is  inadequate  and  the  usefulness  of  those  provided  is  re- 
duced to  a  minimum  by  the  fact  that  neither  soap,  toweling  nor  warm 
water  is  supplied. 

Shower  baths  were  found  in  but  two  elementary  buildings,  and  a 
swimming  pool  in  but  one  of  them. 

*School  Survey,  p.  121. 

**Percentages  incorrect  from  statistical  point  of  view.     Should  add  up  to  exactly 

100.00. 
***Evidently  misprint,  should  be  25  to  49. 

(78) 


The  score  of  elementary  school  buildings  shows  that  water  supply  is 
one  of  the  lowest  items  on  the  score.  A  comparison  of  this  figure  with 
the  same  items  for  high  school  buildings  will  reveal  a  gross  injustice  and 
neglect  of  23,000  elementary  school  children  as  against  a  fair  recognition 
of  the  needs  of  3,833  high  school  pupils. 

HEATING  AND  VENTILATING  SYSTEMS* 

The  1914  report  of  Board  of  School  Inspectors  contains  financial 
statement — expenditures  amounting  to  $132,481.17  for  alterations  and 
improvements  in  heating  plants  in  various  school  buildings  and  presum- 
ably for  ventilating  facilities  for  12  years,  1898-1910.  These  invest- 
ments together  with  those  of  1911-16  period  should  bring  adequate  re- 
turns. Relatively  few  reports  were  made  to  the  Survey  committee  re- 
garding inability  of  heating  apparatus  to  maintain  adequate  temperatures 
in  classrooms.  Themometers  are  practically  useless  because  of  their  pre- 
vailing inaccuracy  throughout  the  city  and  should  be  replaced  by  accurate 
ones. 

Table  XXVIII. 

Showing  Thermometer  Readings  in  Schools  of  St.  Paul  and  Denver** 

St.  Paul  Denver 

No.  of  %  of  No  of  %  of 

Rooms  Rooms  Rooms  Rooms 

Readings  below  60 7  3.9  14  1 

Readings  either  60  or  61 6  3.3  25  2 

Readings   either  62   or   63 8  4.4  56  4.8 

Readings   either  64  or  65 20  11.0  109  9 

Readings  either  66  or  67 38  21.0  160  13 

Standard  either  68  or  69 37  20.4  343  29 

Readings  either  70  or  71 37  20.4  248  21 

Readings  either  72  or  73 15  8.3  113  9 

Readings  either  74  or  75 7  3.9  61  5 

Readings  either  76  or  77 5  2.8  14  1 

Readings  either  78  or  79  0  7  .6 

Readings   either  80  or   above 1  .4  7  .6 

Median  reading  for  181  readings  coming  from  17  schools  in  St.  Paul 
is  68.40.  School  ventilation  tested  by  anemometer  in  12  schools,  54 
classrooms  and  in  2  of  the  4  high  schools,  12  rooms,  making  a  total  of 
66  rooms  tested.  Altho  the  standard  requirement  is  2,000  cubic  feet 
per  hour  per  pupil  for  change  in  air,  only  2  rooms  out  of  the  54  elemen- 
tary rooms  approximated  this  amount.  The  average  amount  of  air 
entering  these  54  rooms  was  811.8  cubic  feet,  the  median  amount  629 
cu.  ft.  High  school  ventilation  better.  Standard  for  high  school  is 
2,500  cubic  feet  per  pupil  per  hour.  3  of  the  12  rooms  reached  the 
standard,  and  6  were  above  the  2,000  point.  Average  air  intake  was 
1,696  cubic  feet  per  pupil  per  hour. 

Humidity  tests  from  181  readings  selected  at  random.  Standard 
humidity  is  40%  in  very  cold  weather,  50%  in  ordinary  winter  -weather. 

♦Abstract  of  findings  in  the  School  Survey  Report. 
**School  Survey  Report,  p.  120. 

(79) 


Only  16%  of  readings  obtained  were  above  29%  relative  humidity  and 
only  7%  of  readings  above  45%  relative  humidity.  Heating  system  has 
made  air  too  dry  and  this  should  be  remedied. 

The  excessive  cost  of  heating  the  St.  Paul  schools  is  due  to  the  over 
supply  of  classroom  cubage,  and  in  some  cases,  the  disproportionate 
amount  of  corridor  space.  Present  day  architects  claim  that  only  32% 
of  the  space  in  a  building  should  be  devoted  to  corridors,  stairways,  and 
the  like,  the  remaining  68%  being  utilized  for  actual  teaching  operations. 
This  should  be  taken  into  consideration  in  all  future  planning  for  the  St. 
Paul  system. 

LIGHTING  OF  CLASSROOMS* 

Model  classroom  should  be  lighted  only  from  left  side  with  windows 
banked  to  within  seven  feet  of  the  front  wall.  Of  St.  Paul's  elementary 
classrooms,  157  approach  the  standard  in  being  lighted  from  the  left 
only,  but  none  are  constructed  with  the  seven  foot  space  at  the  front 
wall.  381  rooms  are  lighted  from  the  left  and  rear,  making  the  teach- 
ers in  those  rooms  face  the  light,  a  situation  which  must  be  intolerable 
during  much  of  the  winter  time  because  of  the  glare  reflected  from  the 
snow, .  and  which  for  that  reason  must  cause  too  many  shades  to  be 
drawn  for  adequate  lighting.  43  rooms  are  lighted  partly  from  the 
front,  causing  the  children  to  suffer  from  the  glare. 

Table  XXIX. 

Showing  Comparison  of  Lighting  in  Denver,  Salt  Lake  City  and  St. 

Paul.** 

Denver  Salt  Lake  St.  Paul 

Lighted  from  left  only 373  96  157 

Lighted  from  left  and  rear 220  250  381 

Lighted  from  right  and  rear 35  3  6 

Lighted  from  right  only 6  2  1 

Lighted  from  rear  only 2  1  1 

Lighted  partly  from  in   front 12  39  A3 

Lighted  from  three  sides 8  46  21 

Lighted  from  four  sides   2  0  0 

Lighted  from  left  and  right   0  3  20 

With  more  than  half  light  from  rear 0  120  68 

Lighted  from  overhead   0  0  6 

Requirement  of  State  Department  of  Education  that  in  each  class- 
room window  area  shall  equal  at  least  20%  of  floor  area.  Plans  of  no 
new  building  passed  which  do  not  meet  this  minimum.  Of  518  class- 
rooms in  St.  Paul,  348,  or  67%  have  less  than  the  required  glass  area. 
Illuminometer  tests  made  in  10  elementary  buildings  and  the  Central 
High  School.  Of  158  measurements  made  in  all  buildings,  43  fall  be- 
low the  minimum  standard  of  9  foot  candles.  Artificial  lighting  either 
not  adequate  or  improperly  placed.  Children  sometimes  compelled  to 
stop  all  work  on  dark  afternoons  because  of  insufficient  light. 

*Abstract  of  findings  in  the  School  Survey  Report. 
**School  Survey  Report,  p.  133. 

(80) 


Color  scheme  in  classrooms  should  be  light  buff,  light  green  or  grey. 
St.  Paul  schools  have  too  much  dark  buff  and  dark  green.  The  window 
shades,  which  should  be  of  a  buff  or  light  sage  color,  are  of  all  kinds 
and  in  all  conditions  in  St.  Paul. 

Before  concluding  the  subject  of  school  sanitation  the  following  un- 
classified notes  from  the  Survey  Report  should  be  cited : 

"Poorly  arranged  and  inadequately  equipped  basements  built  at  great  cost,  add 
largely  to  fuel  and  janitor's  expenses,  but  provide  frequently  no  educational  facilities." 

"Entrances  to  many  buildings  were  not  built  for  the  purpose  of  providing  safety 
for  children." 

"Dangerous  stairways  were  constantly  evident." 

"Corridors  in  many  schools  are  inadequate.  Standard  corridor  should  be  wide 
enough  to  prevent  congestion." 

"Ideal  method  of  cleaning  is  by  vacuum  cleaning  process,  which  permits  thoro 
cleaning  of  walls,  desks,  floors,  and  chalk  rails  without  raising  dust  and  affords  the 
opportunity  for  cleaning  during  school  hours.     No  schools  in  city  use  this  system." 

"Removal  of  ashes  is  inadequate." 

"Coal  bins  are  inadequate,  therefore  sometimes  schools  not  sufficiently  heated  and 
pupils  have  to  be  sent  home." 

From  the  data  on  school  sanitary  and  hygienic  conditions  here  dis- 
cussed certain  conclusions  are  obvious,  and  they  may  be  summed  up  as 
follows : 

Owing  to  the  lack  of  medical  supervision  in  the  parochial  and  pri- 
vate schools  which  are  outside  the  province  of  municipal  control,  23.79% 
of  all  school  children  in  the  city  have  no  medical  or  sanitary  supervision 
and  no  inspection  of  their  school  surroundings. 

It  has  been  noted  that  there  was  considerable  increase  in  the  preval- 
ence of  contagious  diseases,  especially  diphtheria,  scarlet  fever,  pertussis, 
and  small-pox,  in  the  year  1917-1918  as  against  the  preceding  year. 
This  would  seem  to  indicate  a  fact  that  should  be  obvious  also  from  gen- 
eral considerations, — namely  that  the  medical  and  nursing  force,  espe- 
cially the  former,  is  entirely  inadequate  to  meet  the  demand.  It  is  hardly 
to  be  expected  that  one  part-time  medical  inspector  should  be  sufficient  to 
care  for  the  health  of  30,572  children  and  look  after  the  sanitation  of 
their  surroundings.  At  least  four  full-time  physicians  should  be  em- 
ployed, which  would  allow  about  7,500  children  to  each,  none  too  few 
children  if  the  work  is  to  be  carefully  and  conscientiously  done.  In- 
crease in  the  nursing  force  would  be  an  improvement  also,  and  without 
a  doubt  the  usefulness  of  those  now  employed  would  be  increased  great- 
ly if  they  were  given  more  room  and  better  and  more  abundant  equip- 
ment with  which  to  work. 

The  conditions  of  sanitation  in  the  school  buildings  as  revealed  by 
the  School  Survey  Report  are  on  the  whole  below  the  accepted  standard, 
and  in  some  cases  deplorably  so.  Importance  of  remedying  the  de- 
fects along  this  line  as  pointed  out  by  the  Report  can  hardly  be  exagger- 
ated, and  it  is  to  be  hoped  that  immediate  steps  will  be  taken  to  bring 
about  the  necessary  improvements  in  the  extraordinarily  important  field 
of  school  sanitation. 


(81) 


Private  Health  Agencies 

Hospital  Facilities 

There  are  ten  hospitals  in  St.  Paul,  nine  private  ones  besides  the  City 
and  County  Hospital  which  is  under  the  Board  of  Control  of  the  City 
of  St.  Paul  and  Ramsey  County  and  where  all  beds  are  free. 

The  private  hospitals  have  a  total  capacity  of  775  beds,  and  the  City 
and  County  Hospital  a  capacity  of  800  beds,  making  a  total  of  1,575 
beds  available  for  hospitalization  in  the  city.  This  means  that  St.  Paul 
has  6.68  hospital  beds  per  1,000  population,  which  figure  compares  rather 
favorably  with  the  few  other  statistics  we  have  at  hand  in  this  matter, — 
viz :  a  tabulation  given  in  a  community  sickness  survey  made  by  the 
Metropolitan  Life  Insurance  Company  in  1917: 

Table  XXX.    . 

Showing  Number  of  Hospital  Beds  and  Number  of  Physicians  per  1,000 
Population  in  Specified  Cities.* 

Cities  Per  1000  general  population 

Available  Hospital  beds  Physicians 

Pittsburgh    7.1  2.0 

Boston     9.8  2.7 

Kansas  City  5.8  3. 1 

Because  of  war  conditions  and  consequent  continual  change  and  de- 
pletion of  the  medical  force  no  satisfactory  figures  could  be  obtained  re- 
garding the  number  of  physicians  per  1,000  population  in  St.  Paul.  Un- 
doubtedly in  normal  times  it  would  not  vary  greatly  from  the  number 
quoted  above. 

All  of  the  ten  hospitals  in  St.  Paul  care  for  all  kinds  of  diseases  with 
the  exception  of  contagious  disease,  altho  the  City  and  County  Hospital 
admits  all  contagious  diseases  except  small-pox.  The  number  of  cases 
treated  in  all  the  hospitals  during  their  last  fiscal  year  was  24,946,  8,860 
of  these  being  patients  in  the  City  and  County  Hospital. 

Because  of  their  private  support  it  is  impossible  to  give  a  detailed  ac- 
count of  any  of  the  hospitals  other  than  the  City  and  County  which  is, 
as  has  been  already  stated,  under  the  supervision  of  and  responsible  to 
the  City  and  County  Board  of  Control. 

The  following  statistical  data  regarding  the  work  in  the  City  and 
County  Hospital  is  taken  from  the  Annual  Report  of  the  Board  of  Con- 
trol for  the  year  ending  December  31,  1917: 

Largest  number  of  patients  under  treatment  at  any  one  time....  631 

Smallest  number  of  patients  under  treatment  at  any  one  time 425 

Daily  average  number  of  patients    516 

Daily  average  number  of  patients  and  employes    820 

^Sickness  Survey  of  Principal  Cities  in  Pennsylvania  and  West  Virginia.  By  Lee 
K.  Frankel,  Ph.  D.,  3rd  Vice-President  and  Louis  I.  Dublin,  Ph.  D.,  Statistician,  Metro- 
politan Life  Insurance  Company,  New  York,  1917,  p.  40. 

(82) 


Average  number  of  days'  stay  by  patients    21 

Total   number  of   days'  treatment  given  in   hospital 188,520 

Number  of  out  patients  treated  in  hospital  dispensary    4,397 

Number  of  calls  at  patients'  homes 5,540 

Results : 

Discharged    "well"    3,603 

Discharged  "improved"  3,687 

Discharged  "unimproved"   339 

Died 679 

Remaining  under  treatment  December  31,  1917 542 

Total  8,860 

Charitable  and  Welfare  Agencies  Devoting  Part  or  Whole 
Time  to  Health  Work 

Of  the  various  organizations  doing  charitable  or  welfare  work  in  St. 
Paul,  there  are  six  that  give  some  time  at  least,  to  health  work,  three  of 
the  six  being  in  existence  for  that  sole  purpose.  Those  three  are  The 
Children's  Preventorium  of  Ramsey  County,  The  St.  Paul  Baby  Welfare 
Association,  and  the  Minnesota  Public  Health  Association,  while  the 
other  agencies  with  Health  programs  are  the  United  Charities,  the  Am- 
herst H.  Wilder  Charity,  and  the  Metropolitan  Life  Insurance  Company. 

Description  of  the  work  done  by  these  various  organizations  for  the 
promotion  of  health  is  given  herewith. 

CHILDREN'S  PREVENTORIUM  OF  RAMSEY  COUNTY 

The  Children's  Preventorium  has  for  its  object  the  care  of  children 
who  have  been  infected  with  tuberculosis  but  in  whom  the  disease  is 
not  in  active  stage.  It  endeavors  by  proper  care  and  training  to  develop 
their  powers  of  resistance  so  that  they  are  more  nearly  immune  not  only 
to  tuberculosis  but  to  other  diseases  as  well.  The  work  is  supported 
financially  by  subscriptions  and  the  proceeds  of  Tag  Day.  Patients  rec- 
ommended by  the  visiting  nurses  of  the  Tuberculosis  Division  are  ex- 
amined by  a  physician  on  the  staff  and  are  admitted  by  him.  The  only 
limitations  are  those  of  age  and  numbers; — ages  admitted  being  from 
five  to  twelve  years,  and  the  accommodations  unfortunately  being  for 
only  forty-five.  The  work  is  carried  on  under  the  supervision  of  a 
Board  of  Directors,  and  is  in  the  immediate  care  of  a  medical  staff, 
and  a  superintendent  who  is  a  registered  graduate  nurse  with  ex- 
perience in  this  line  of  work.  There  are  also  an  assistant  nurse  and  a 
school  teacher.  The  school  is  on  the  open-air  plan,  and  is  so  conducted 
educationally  that  the  children  are  up  to  grade  on  their  return  to  the 
public  schools. 

A  few  figures  showing  some  of  the  results  of  the  work  for  1917  are 
as  follows : 

Number  of  institution  days  9,541 

Average  residence,  per  patient,  days 153.8 

Average  gain,  per  patient,  pounds 4.25 

Greatest  individual  gain,  pounds  19.25 

(83) 


The  financial  statement  for  the  same  year  is  contained  in  the  follow- 
ing: 

General  Account,  year  ending  December  31,  1917. 

Receipts    1915-1916 $24,177.11 

Receipts  1917  to  date   (not  including  Tag  Day) 8,615.35 

Receipts  Tag  Day,   1917 12,955.19 

General  Expense    $4,814.10 

Furniture  and  Fixtures    607.43 

Salary   Account    2,767.92 

Food   Supplies    5,773.88 

Insurance,  Taxes,  etc    194.40 

Tag  Day  Expense 271.66 

Building  Maintenance,  Improvements, 

etc.,   1,450.49 

Total    Expenditures 15.879.88 

Total  Expenditures  1915-1916   .   18,423.53 
Cash  on  hand  Dec.  31,   1917. . .  11,444.24 

Total $45,747.65       $45,747.65 

It  has  been  pointed  out  already  in  the  chapter  on  Tuberculosis  Control 
that  there  is  always  a  waiting  list  for  the  Preventorium.  In  view  of  the 
fact  that  anti-tuberculosis  work  with  children  is  so  important  because  it 
strikes  at  the  root  of  the  problem  for  future  generations,  it  is  to  be 
strongly  recommended  that  the  facilities  at  the  Preventorium  be  enlarged 
so  that  there  may  be  as  little  delay  as  possible  in  meeting  the  local  needs. 

ST.  PAUL  BABY  WELFARE  ASSOCIATION 

The  purpose  of  the  St.  Paul  Baby  Welfare  Association  is  the  reduc- 
tion of  infant  mortality  through  the  education  of  mothers.  Financially 
the  Association  is  supported  by  subscriptions,  and  also  by  donations 
from  the  Scottish  Rite  Masons,  the  Wilder  Charity,  and  from  the  Board 
of  Control  in  return  for  services  rendered  by  the  Association.  The  bene- 
fits of  the  work  are  open  to  any  suitable  person  who  cannot  afford  a  baby 
specialist.  The  Association  is  an  incorporated  body  affiliated  with  the 
national  organization,  supervised  by  a  Board  of  Directors,  and  in  the 
immediate  charge  of  a  medical  staff  and  a  supervising  nurse  whose  quali- 
fications, other  than  that  of  being  a  registered  and  graduate  nurse,  are 
fixed  by  the  Board  of  Directors.  There  are  six  nurses  on  the  staff  be- 
sides the  supervisor,  the  salaries  of  two  of  these  being  appointed  and  paid 
by  the  Wilder  Charity.  Regular  baby  clinics  are  held  on  Mondays,  Wed- 
nesdays, and  Fridays  at  12:30  P.  M.,  while  there  are  prenatal  clinics  on 
two  days  a  week, — Tuesdays  and  Thursdays  at  1 :00  P.  M. 

The  work  acomplished  in  the  year  ending  May  1,  1917,  is  as  follows : 

Babies  cared  for 1,366 

Clinic    Attendance    3,090 

Deaths    40 

(84) 


Prenatal  clinics  opened  in  July,  1916: 

Julv  to   May,  cases   registered 95 

Of  those— 

71  delivered. 

68  healthy  children 

2  stillbirths 

1  miscarriage 

The  following  financial  statement  is  for  the  year  ending  April  30, 
1918,  and  involves  only  the  money  raised  by  popular  subscriptions,  since 
the  Scottish  Rite  Masons,  the  Wilder  Charity,  and  the  Board  of  Con- 
trol make  their  payments  direct  from  their  treasuries  so  that  such  funds 
do  not  pass  through  the  hands  of  the  Treasurer  of  the  Baby  Welfare 
Association. 

RECEIPTS 

Cash  on  hand,  May  1,  1917   $1,547.59 

Total  Receipts  year  ending  April   30,    1918    5,241.60 

$6,789.19 
EXPENDITURES 

Auto    expenses    $  191.87 

Salaries    (Head  Nurse,   2  Asst. 

nurses  and  stenographer)    4,082.46 

Printing,    Postage,    etc 126.69 

Carfare     109.00 

Laundry    73.46 

Telephones     45.60 

Drugs     308.39 

Incidentals     22.28 

Total    expenditure     $4,959.77 

Balance    on   hand,    May    1,    1918    $1,829.42  $6,789.19 

Much  of  the  reduction  of  the  infant  mortality  rate  in  the  last  few 
years,  particularly  for  1915  and  1916,  is  due  undoubtedly  to  this  organi- 
zation, which  aside  from  direct  care  of  babies  took  the  initiative  in  wag- 
ing campaigns  against  the  use  of  midwives  and  for  the  control  of  baby 
farms. 

THE  MINNESOTA  PUBLIC  HEALTH  ASSOCIATION 

The  objects  of  the  Minnesota  Public  Health  Association  are  "to  con- 
tinue the  anti-tuberculosis  educational  campaign  inaugurated  by  the  Min- 
nesota Association  for  the  Prevention  and  Relief  of  Tuberculosis,  and 
further  to  promote  the  cause  of  Public  Health  in  Minnesota,  and  to  co- 
operate with  state  and  local  authorities  in  carrying  out  their  programs." 

The  financial  resources  of  the  Association  are  voluntary  contributions 
and  the  results  of  Red  Cross  Seal  sales.  This  is  a  State  organization 
and  therefore  any  community  in  the  State  receives  speakers,  literature, 
exhibits,  nurses,  and  other  services  upon  request.  The  work  is  super- 
vised by  a  board  of  directors  and  given  immediate  attention  by  an  Exec- 
utive Secretary  whose  main  qualifications  are  those  of  a  medical  man, 

(85) 


experienced  in  public  health  and  social  problems.  There  are  ten  nurses 
on  the  nursing  staff,  all  of  whom  work  throughout  the  State  having  head- 
quarters only  in  St.  Paul.  The  only  work  done  directly  in  this  city  by 
the  Minnesota  Public  Health  Association  is  propaganda  work,  one  of 
the  main  instruments  of  which  being  their  monthly  bulletin,  "The  Min- 
nesota Health  Journal." 

A  classification  of  the  work  done  is  as  follows : 

Anti-tuberculosis  work. 

Health  work  in  schools. 

State  health  insurance. 

Local  study  clubs. 

Health  legislation. 

Field  work  in  the  counties  where  there  are  sanatoria. 

The  financial  statement  for  the  half  year  from  January  1,  1918  to 
June  30,  1918  is  given  below: 

Cash  Balance  at  beginning  of   Fiscal   Year $7,209.13 

Total  Receipts  from  sale  of  Red  Cross  seals   49,266.59 

Total  Receipts  from  all  other  sources 2,641.31 

Total  Receipt  for  half  fiscal  year 51,907.90 

Total  Receipts  and  cash  for  one-half  the  year   59,117.90 

Total  Expenses  for  one-half  the  fiscal  year : 

Administrative  expenses    9,617.22 

Educational   work    2,673.14 

Field  and  traveling  expenses 47.10 

Nurses 9,605.32 

Total    expenses    21,943.32 

Cash  balance  in  Treasury  at  close  of  Fiscal  Year 37,173.71 

Since  the  Minnesota  Public  Health  Association  is  essentially  a  State 
organization  and  since  there  are  several  local  agencies  for  tuberculosis 
prevention,  the  work  of  the  Public  Health  Association  is  necessarily  limit- 
ed in  St.  Paul  to  educational  work. 


HEALTH  WORK  OF  THE  AMHERST  H.  WILDER  CHARITY 

Besides  the  more  conspicuous  parts  of  the  Wilder  Charity's  health 
program  the  Visiting  Nurse  Department  and  the  Health  Center,  the  in- 
stitution also  pays  for  the  support  of  two  nurses  for  the  Baby  Welfare 
Association,  pays  for  two  beds  at  St.  Luke's  hospital,  and  pays  for  the 
care  of  15  children  a  month  at  the  Children's  Preventorium.  An  ac- 
count of  the  Wilder  Charity  Visiting  Nurse  Department  and  the  Health 
Center  are  given  below . 

Wilder  Charity  Visiting  ATurse  Department : 

The  purpose  of  this  agency  is  "to  provide  trained  nurses  to  visit,  in 
their  own  homes,  sick  persons  otherwise  unable  to  secure  skilled  attend- 
ance who  cannot  or  should  not  be  sent  to  a  hospital,  and  to  teach  their 

(86) 


family  or  those  attending  them  how  to  give  them  proper  care." 
For  its  financial  resources  the  work  is  dependent  entirely  upon  the 
funds  of  the  Amherst  H.  Wilder  Charity.  In  no  case  are  the  nurses 
allowed  to  receive  any  payment  from  the  people  they  attend,  and  if 
those  people  are  able  to  pay  the  regular  cost  of  a  trained  nurse,  they  are 
expected  to  do  so,  and  are  not  permitted  to  receive  the  care  of  the  Wilder 
nurses.  However,  in  every  case  one  visit  is  made  to  the  family  calling 
for  nurse's  care  so  that  it  may  be  ascertained  whether  or  not  the  family 
is  able  to  pay  for  private  nursing.  The  work  is  under  the  jurisdiction 
and  direction  of  the  Wilder  Charity,  and  under  the  immediate  supervi- 
sion of  a  head  nurse,  whose  chief  technical  qualification  is  to  be  a  regis- 
tered nurse.  The  Head  Nurse  spends  part  of  her  time  at  the  Free  Medi- 
cal Dispensary  where  she  is  in  charge,  and  the  rest  in  supervision  of  the 
other  Wilder  nurses  of  whom  there  are  four.  A  summary  of  the  work 
accomplished  during  the  year  1916-1917,  is  as  follows: 

Total  number  of  patients  on  visiting  list  June  30,   1916 119 

Total  number  of  patients  on  visiting  list  June  30,  1917 122 

Total  number  new  patients  during  year 588 

Total  number  patients  during  year 707 

Total  number  recorded  visits  made 8,336 

Total  number  unrecorded  visits  made    273 

Total  number  visits  made   8,609 

Total  number  cured 445 

Total  number  improved    101 

Total   number  unknown    22 

Total    number    died    32 

Total   number   sent   to   hospital 31 

Families  supplied  with  from  1  pint  to  2  quarts  of  milk  daily 67 

Families  supplied  with  eggs,  1  dozen  weekly 27 

The  financial  statement  for  the  year  1916-1917  shows  the  following 
distribution  of  expenditures : 

Salaries $1,080.00 

1,020.00 

1,020.00 

1,020.00 

945.00 

40.00 

30.00 

92.00 

Drugs  and  dressings 525.79 

Milk  and  eggs    2,089.92 

Car  fares  and  sundry  expenses    , 454.47 

Total    $8,317.18 

The  usefulness  of  the  Wilder  Charity  Visiting  Nurse  Department 
would  be  extended  considerably  if  nominal  payments  for  intermittent 
service  were  allowed  from  people  who  cannot  afford  to  pay  for  a  nurse 
continuously  and  yet  who  are  not  needy  enough  to  be  admitted  without 
charge  to  the  privileges  of  the  nursing  service  under  present  conditions. 

(87) 


An  important  addition  to  the  health  service  of  the  Wilder  Charity  is 
now  being  projected.  This  is  a  central  dispensary  to  be  called  the  Am- 
merst  H.  Wilder  Dispensary  and  to  be  located  on  Rice  Street  between 
Summit  and  College  Avenues,  near  the  Miller  Memorial  Hospital  with 
which  it  will  co-operate.  Plans  for  the  building  are  very  nearly  per- 
fected and  it  is  expected  that  the  work  will  be  completed  so  that  the 
Dispensary  can  start  operations  by  September,  1919.  Besides  the  Dis- 
pensary there  will  be  organized  a  number  of  Health  Centers,  probably 
four  or  five,  similar  to  the  one  now  in  operation  which  will  act  as  feed- 
ing stations  to  the  Central  Dispensary,  and  which  will  care  for  slight  ail- 
ments not  requiring  intensive  medical  care  besides  being  centers  for 
general  health  education. 


The  Health  Center. 

The  Health  Center  was  started  in  November,  1917,  for  the  purpose 
of  giving  curative  and,  more  especially,  preventive  medical  care  to  per- 
sons within  the  Health  Center  district  who  are  unable  to  pay  for  private 
treatment,  and  also  with  the  further  intent  to  help  the  people  of  that  dis- 
trict to  build  up  their  standards  of  physical  health  and  efficiency. 

For  financial  resources  the  Health  Center  depends  entirely  upon  the 
Wilder  Charity. 

All  persons  living  within  the  district  are  urged  to  have  a  general  medi- 
cal examination,  by  their  own  physician,  or  if  they  are  unable  to  afford  a 
private  physician,  they  are  given  free  service  at  the  clinics. 

The  work  is  under  the  direction  and  jurisdiction  of  the  Wilder  Char- 
ity, and  immediately  under  a  supervisor  who  has  had  medical  training 
and  experience  in  social  work.  Besides  the  paid  assistance  of  a  clerk 
and  trained  nurse,  there  is  a  considerable  amount  of  volunteer  help, — a 
gymnasium  teacher  for  the  girls  and  one  for  the  boys,  a  coach  for  the 
boys'  athletics,  a  swimming  teacher,  and  four  district  workers  for  the 
follow-up  social  work.  The  order  of  the  clinics  at  the  present  time  is  as 
follows : 

Tuesdays   10  A.  M General 

Wednesdays  9  to  12  A.  M Dental 

Wednesdays  3:30  P.  M Eye 

Thursdays  9  to   12  A.   M. General 

Fridays  9  to  12  A.  M. Dental 

An  account  of  the  work  accomplished  for  the  year  1918  is  as  fol- 
lows: 


(88) 


oo 

T— I 

On 


P5   ifl   H   tJ-   P)    M   Oi 


m 


w 


t^  I**  ■* 

VO    r^    M    O 

r^  co  \o 

Tf   CO   CO 

CO           "* 

IT)       VO     i-H 


i— i  i— i    CM  m  CM   Os 


CM   1^   i-i    00  to   VO  CO       '   O 


3 

i— 1    "   "    Tj-    ~     T-H    VO         "    CM    J*    VO 


D^ 


L> 


CO     i-l  i-H 


VO       VO    lO  T-H 


N     ifl   (O 


<0     OHO    H   W 


N   O   rH   (M   ■?   (V)   N  CM   £,   00 


t^  m  cm    vo  to 

O   CM    CO     t-h    i-H 
to  «*5 


tO      T-H    CO 

CM 


t-h  to  CM  CO 


HC>N00iOt0OHC0« 
tJ-hNt|t4-NCv1h 


OV  Ov     ON  CM 

m        in 

CM  CM 


"^CM^-tOCN'-'^'-'O  in  lO     hh 

v^     ^  to  i— I  r-l 


vO^Ovor^CMO\COC\^"f>Jto 

m   1/)    h    H    VO   i-*    "5  H    N   N 

CM 


to         cj    in  to 

CO  CO      CO    I-H 

CM  CM 


co     U 
tj    PL| 


-M 

-a 

"3 

7^ 

T3 

-G 

<  u 

03 

ns 

|H 

l-H 

cu 

cu 

C 

a 

CD 

CU 

o  o 

VO  in  to  to           to     CM    Ov 

CM   CM  t^          r^    i-< 

CM  l-H                l-H 

o  W 
o  w 

:     .  Q<  j 

,Q  (u   ,'?     (11    (/I 

.    o     •    c     -Hj^^U^ 

en     ."S    S    o  •£  H  g    g    u  H 

£  £   S££-So  sskO 


— '  l-H        "J 


o  \n 


53    a  .s    cu 

mOWQ 


(89) 


VOLUNTEER  WORK. 

One  registered  nurse  and  2  senior  nurses  have  given  service. 

Volunteer  district  workers  help  us  keep  in  touch  with  families. 

Classes  in  corrective  and  general  gymnastics,  organized  games  and  danc- 
ing are  held  regularly  for  both  girls  and  boys. 

Swimming  classes  are  held  for  both  girls  and  boys. 

Health  Center  clubs  for  both  girls  and  boys  are  active. 

Athletic  teams  for  both  girls  and  boys  represent  the  Health  Center. 

All  of  these  activities  are  under  the  direction  of  competent  physical  in- 
structors. 

The  Health  Center  co-operates  with  the  following  agencies :   the  Lincoln 
School,  School  Nurses,  City  Playgrounds  Department,  City  Physi- 
cians,  Hope  Chapel,   United  Charities,   Red  Cross,  University  of 
Minnesota  and  local  hospitals. 
The  financial  statement  from  November  1917  to  June  1918  is  as  fol- 
lows: 

Salaries    $1,835.00 

Other  expenditures    1,046.97 

At  least  one  other  center — at  the  Market  Place  Playground — is  con- 
templated. It  should  be  thoroughly  understood  that  Health  Centers  are 
not  intended  for  the  treatment  of  disease,  but  for  medical  examinatiion 
and  treatment  of  minor  ailments  which  are  ordinarily  neglected  and  there- 
fore are  not  likely  to  receive  treatment  at  a  central  clinic  before  they  be- 
come serious  ailments. 

HEALTH  WORK  OF  THE  UNITED  CHARITIES 

The  work  done  by  the  United  Charities  along  health  lines  is  carried 
on  through  the  Free  Medical  Dispensary,  the  Adult  Dental  Clinic,  and 
the  Committee  on  Tuberculosis,  and  the  purpose  of  the  work  is  first  to 
give  medical  care  to  those  who  are  unable  to  pay  the  regular  fee,  and 
second,  to  promote  the  general  health  conditions  of  the  community.  The 
financial  resources  are  from  voluntary  subscriptions  in  the  case  of  the 
Free  Medical  Dispensary  and  the  Adult  Dental  Clinic,  and  for  the  Tuber- 
culosis Committee,  Red  Cross  Christmas  Seal  sales.  Applicants  are  ad- 
mitted without  question  to  the  Free  Medical  Dispensary  and  the  Adult 
Dental  Clinic  when  referred  by  recognized  charitable  organizations,  and 
personal  applicants  are  admitted  on  satisfactory  evidence  of  need  and 
inability  to  pay  private  physicians. 

The  direction  of  the  entire  health  program  is  in  the  hands  of  the 
Board  of  Directors  of  the  United  Charities  of  St.  Paul,  Executive  Com- 
mittee, and  the  Committee  on  Health ;  the  immediate  direction  of  all  pro- 
fessional work,  however,  is  with  a  Chief  of  Staff  in  the  case  of  the  Free 
Medical  Dispensary,  and  with  the  Oral  Hygiene  Committee  of  the  Ram- 
sey County  Dental  Association  in  the  case  of  the  Adult  Dental  Clinic. 

(90) 


The  qualifications  for  the  supervising  head  are  as  follows, — professional, 
medical  and  dental  endorsement  of  the  Ramsey  County  Medical  and  the 
Ramsey  County  Dental  Associations  respectively;  medical  social  service, 
professional  training,  and  experience  in  recognized  institutions. 
Clinic  schedule : 

FREE  MEDICAL  DISPENSARY  CLINICS 

MORNING  CLINICS    9-11:30  A.   M. 

1.     Adult    Dental     Daily 

AFTERNOON  CLINICS   1-2  P.  M. 

1.  Medical Tues.,    Thur.,    Sat. 

2.  Children's     Thurs.,    Sat. 

3.  Eye    Tues.,    Thur.,    Sat. 

4.  Refraction    Mon.,    Wed.,    Fri. 

(Appts.   made   Tues.,   Thur.,    Sat.) 

5.  Ear,   Nose  and  Throat    Tues.,  Thurs.,   Sat. 

6.  Skin    Mon.,    Fri. 

7.  Orthopedic    Tues.,  only. 

8.  Surgical     Fri.,    only. 

9.  Dental  cards   for  children    Mon.,   Wed.,    Fri. 

10.  Women's    Tues.,    Sat. 

4:30-6:30   P.   M. 

11.  Venereal  for  women  and  children Monday 

EVENING    CLINICS    8:00    P.    M. 

1.  Venereal    for   men    Tues.,    Thurs. 

2.  Venereal   for  women    Wed. 

A  summary  of  the  work  accomplished  during  the  last  year  is  con- 
tained in  the  following: 

FREE  MEDICAL  DISPENSARY— Sept.  1,  1917  to  Sept.  1,  1918 

Patients 
New 

Medical    558 

Surgical     220 

Orthopedic    93 

Eye    978 

Ear    174 

Nose   and   Throat 723 

Women's    201 

Children's    434 

Nervous  and  Mental 16 

Skin    411 

TOTAL    ,...3,808  8,100  11,908  232 

ADULT  DENTAL  CLINIC— Sept.  10,  1917  to  Sept.  30,  1918. 

Old  Patients  New  Patients  Total 

983  349  1,332 

Amalgam  fillings    182 

Cement  fillings    250 

Crowns    9 

Treatments   395 

Extractions    754 

Cavities    501 

Cleanings     145 

Plates   57 

Plates  repaired 4 

Reset    Crowns    , 1 

(91) 


Old 

Total 

Operations 

1,291 

1,849 

302 

522 

11 

168 

261 

3.306 

4,284 

312 

486 

722 

1,445 

220 

416 

617 

599 

1,033 

51 

67 

933 

1,344 

1 

The  financial  statement  available  is  for  the  year  ending  September  1, 
1917,  and  is  as  follows: 

DISBURSEMENTS 

Adult    Dental    Clinic    $1,608.01 

Free  Medical  Dispensary    4,036.77 

Cleveland  School  Dental  Clinic   673.36 

Anti-tuberculosis    Dept.    including   open-air 
Class  room  and  Red  Cross  Seal  cam- 
paign,  with  payments  to   State  and  Na- 
tional Ass'ns.  including  1916  campaign       5,069.13 

Total   $11,387.27 

Altho  not  wholly  under  the  auspices  of  the  United  Charities,  the  re- 
cently opened  Venereal  Disease  clinics  may  well  be  discussed  here.  The 
clinic  was  opened  the  first  of  October  under  the  following  arrangements. 
The  salaries  of  the  attending  physicians  are  paid  out  of  State  funds,  the 
equipment  and  social  service  is  furnished  by  the  United  Charities,  as  well 
as  the  necessary  dispensary  room  at  the  St.  Paul  Free  Dispensary,  and 
nurses'  assistance  to  the  physicians  is  rendered  by  two  of  the  Wilder 
Charity  Nurses.  There  are  four  glinics  a  week, — for  the  men  Tuesdays 
and  Thursdays  at  7  P.  M.,  and  for  the  women  Mondays  at  4:30  P.  M., 
and  Wednesdays  at  7  P.  M.  The  latter  are  in  the  charge  of  a  woman 
physician. 

The  clinic  has  been  established  such  a  short  time  that  we  can  present 
a  record  of  work  done  for  only  the  period  from  October  first  to  January 
first  and  that  is  as  follows : 


Old  cases 

New  cases 

Total 

Discontinued  Treatment 

Cases 

No.  of 

Month 

remaining 

admit- 

under 

With       Without 

remain- 

treatmenti 

under  care 

ted 

care 

permission   permission 

ing 

given 

Oct 

47 

47 

14 

33 

50 

Nov 

33 

59 

92 

11 

2 

79 

165 

Dec 

79 

43 

122 

19 

103 

209 

TOTAL 

149 

44 

2 

424 

Patients  treated : 

Syphilitic   only    49 

Gonorrheal    only    56 

Both 7 

Total    112 

Examined  only: 

Negative    36 

Diag.   deferred 1 

Total    37 

Patients  referred  to  Veneral  Clinic  from 

Reading  News  Account    48 

State  Board  of  Health  ' 38 

Social    Service    Department 22 

General    Dispensary    12 

Outside   Physician    7 

United  Charities  6 

Baby  Welfare  Association   6 

Other  patients  of  Clinic  5 

Police  Court    3 

Citv  and  County  Hospital  2 

Total  149 

(92) 


It  is  gratifying  that  the  city's  need  for  venereal  disease  control  is  be- 
ing met  in  so  efficient  a  manner.  It  is  a  pity,  however,  that  such  work 
and  the  other  dispensary  work  has  to  be  carried  on  under  the  difficulty  of 
an  inadequate  building. 

NURSING  SERVICE  OF  THE  METROPOLITAN  LIFE 
INSURANCE  COMPANY 

The  aim  of  the  nursing  branch  of  the  Metropolitan  Life  Insurance 
Company  is  to  provide  nursing  service  to  policy  holders  insured  under 
industrial  policies,  and  to  promote  educational  work  through  circulars  on 
the  care  of  the  health.  All  policy  holders  insured  under  industrial  pol- 
icies are  eligible  to  receive  nursing  service,  with  a  limitation  in  respect  to 
maternity  cases.  The  work  is  under  the  direction  of  the  welfare  De- 
partment of  the  Metropolitan  Life  Insurance  Company,  and  under  the 
immediate  supervision  of  a  graduate  registered  nurse  who  must  qualify 
as  a  visiting  nurse,  and  who  has  one  assistant,  these  two  composing  the 
nursing  force.  For  financial  resources  the  nursing  work  of  the  Welfare 
Department  has,  of  course,  the  backing  of  the  Metropolitan  Life  Insur- 
ance Company.  In  the  year  1917  the  amount  spent  was  $1,561.13,  which 
meant  a  cost  per  visit  of  $0,609  and  a  cost  per  policy  of  $0,056.  A  com- 
parison of  the  cost  per  visit  with  that  of  the  nursing  service  of  the  Wilder 
Charity  shows  a  cost  for  the  latter  of  $0,662,  or  $0,053  more  than  that  of 
the  Metropolitan  Life  Insurance  nursing  service.  In  both  cases  the  cost 
is  computed  on  the  basis  of  salaries  alone,  with  no  drugs  or  dressings  in- 
cluded, since  the  Metropolitan  Welfare  Department  does  not  furnish 
them  as  does  the  Wilder  Visiting  Nurse  Department. 

The  number  of  patients  treated  by  the  Metropolitan  Welfare  Depart- 
ment per  thousand  policies  in  that  year  were  35.207.  Besides  actual 
nursing  work  done,  there  was  a  considerable  amount  of  educational  work 
accomplished  in  1917,  as  may  be  seen  from  the  following: 


CIRCULARS  AND  BULLETINS  USED  IN  1917. 

All  about  Milk   1,300 

Child    3,775 

Child   (Foreign)    385 

Fake  Consumption  Cures  575 

First  Aid  in  the  Home 5,575 

Food  Facts   3,000 

Health  of  the  Worker 530 

How  to  Live  Long   635 

Magic  Health  Book  900 

Safety  First  Booklet 600 

Teeth,  Tonsils  and  Adenoids 1,280 

War   on   Consumption    225 

First  Steps    3,080 

Fly   • 100 

Milk  Circular  300 

Total   22,260 

(93) 


In  addition  special  campaign  work  was  done  in  Baby  Week,  and  dis- 
tributions were  made  in  the  schools,  Bureau  of  Health,  and  the  Red 
Cross. 

It  perhaps  would  be  advantageous  to  both  the  Welfare  Department  of 
the  Metropolitan  Life  Insurance  Company  and  the  Visiting  Nurse  De- 
partment of  the  Wilder  Charity  to  combine  nursing  service  and  to  have 
it  maintained  under  one  organization.  Since  the  Wilder  Charity  has  the 
larger  staff,  it  might  be  well  to  have  the  Metropolitan  Life  Insurance 
Company  pay  the  Wilder  Nursing  Department  for  nursing  service  ren- 
dered to  the  former's  policy  holders,  and  obviate  the  disadvantage  of 
maintaining  two  organizations. 

Health  Work  of  Professional  and  Commercial 
Organizations 

ST.  PAUL  ASSOCIATION  OF  COMMERCE 

The  work  of  the  Health  Committee  of  the  St.  Paul  Association  of 
Commerce  is  mainly  educational.  It  was  the  body,  for  instance,  which 
started  the  discussion  eventuating  in  the  establishment  of  a  venereal  dis- 
ease clinic  under  the  auspices  of  the  Division  on  Venereal  Diseases  of  the 
State  Board  of  Health,  the  United  Charities,  and  the  Wilder  Charity 
nurses.  Of  a  more  recent  date  it  took  the  initiative  in  raising  such  a 
public  demand  for  more  drastic  measures  of  dealing  with  the  epidemic  of 
influenza  that  a  Citizens'  Influenza  Committee  was  appointed  by  the  Com- 
missioner of  Public  Safety  which  took  into  its  own  hands  such  preventive 
and  remedial  work  as  the  City  Health  Department  was  unable  to  do  be- 
cause of  its  involvement  in  much  "red  tape",  and  accomplished  excellent 
results  thereby. 

ORAL  HYGIENE  COMMITTEE  OF  THE  ST.  PAUL  DISTRICT 

DENTAL  SOCIETY 

The  health  work  of  the  Oral  Hygiene  Committee  of  the  District 
Dental  Society  is  largely  propaganda  of  an  educational  nature.  At  the 
present  time  the  Committee  supervises  the  work  of  the  dentists  at  the 
dental  clinics  at  the  Edison  and  Cleveland  Schools.  These  clinics  are 
held  every  morning  from  9  until  12  and  are  not  only  for  the  children  in 
those  schools,  since  after  they  are  all  cared  for  there  are  admitted  to 
clinic  service  children  from  five  other  schools  as  well.  The  dentists 
working  at  the  adult  dental  clinic  at  the  Free  Medical  Dispensary  are 
also  supervised  by  the  District  Dental  Society.  The  United  Charities 
pay  for  their  services  and  materials  used,  and  originally  they  bore  like 
expenses  for  the  school  clinics,  altho  now  the  Department  of  Education 
has  taken  over  such  expenses. 

(94) 


Conditions  of  Health  in  Industry 

State  legislation  regarding  the  promotion  of  health  in  industry  is  very 
meager, — in  fact  all  there  is  is  merely  on  sanitation  and  not  on  medical 
matters.  A  compilation  of  the  labor  laws  of  the  State  affecting  health  or 
sanitation  in  the  industrial  world  is  given  below : 

"3837.  SEATS  FOR  FEMALES— Every  employer  of  females  in 
any  mercantile,  manufacturing,  hotel,  or  restaurant  business,  and  ev- 
ery agent  in  charge  of  any  such  business,  shall  provide  and  maintain 
suitable  seats  in  the  room  where  they  work,  and  permit  such  use  thereof 
by  them  as  may  be  necessary  for  the  preservation  of  their  health." 

"3887.  (As  amended  by  Chap.  288.  G.  L.  1911)  CLEANLINESS, 
ETC. — Every  building  in  which  labor  is  employed  shall  be  kept  clean  and 
free  from  effluvia  arising  from  any  sewer,  drain,  or  privy;  be  properly 
ventilated;  and  provided  with  privies  for  the  separate  use  of  male  and 
female  employes,  to  the  number  of  at  least  one  of  such  closets  for  each 
twenty-five  persons  employed,  properly  screened,  and  at  all  times  kerjt. 
in  a  sanitary  condition.  Whenever  the  labor  performed  is  such  as  to 
require  a  change  of  clothing,  separate  dressing  rooms  shall  be  provided 
for  the  sexes.  Suitable  receptacles  for  sputum  shall  be  provided  by  the 
employers,  the  same  to  be  of  such  form  and  construction  and  of  such 
number  as  shall  be  satisfactory  to  the  state  board  of  health,  or  the  com- 
missioner of  labor  and  his  assistants." 

"3890.  BAKERIES  AND  CONFECTIONERY  ESTABLISH- 
MENTS.— Every  bakery  and  confectionery  establishment  shall  be  of 
good  workmanship,  well  drained,  and  constructed  and  plumbed  accord- 
ing to  established  sanitary  principles.  Every  room  used  for  the  manu- 
facture, storage,  or  sale  of  bread  or  other  food  products  shall  be  light, 
dry,  and  airy.  The  floors  and  walls  of  every  room  used  for  the  manu- 
facture of  such  food  products  shall  be  so  constructed  as  to  exclude  rats, 
and  other  vermin,  be  at  all  times  free  from  moisture,  and  kept  in  good 
repair.  Its  floors  shall  have  a  smooth  surface,  constructed  of  wood, 
cement,  or  tile  laid  in  cement,  save  that  when  it  is  more  than  four  feet 
below  the  level  of  the  street  or  adjacent  ground,  it  shall  never  be  con- 
structed of  wood.  Its  walls  and  ceilings  shall  be  whitewashed  at  least 
once  in  three  months,  and  the  floors,  utensils,  and  furniture  of  such  room, 
and  of  every  room  used  for  the  storage  or  sale  of  such  food  products, 
shall  be  so  arranged  as  to  be  easily  kept  clean,  and  together  with  the 
wagons  used  for  its  delivery  shall  be  kept  in  a  clean  and  sanitary  con- 
dition. No  water  closet,  earth  closet,  privy,  ash  pit,  or  sleeping  room  for 
workmen  shall  be  in,  or  communicate  directly  with  any  bake-room  or 
with  the  kitchen  of  any  hotel  or  public  restaurant." 

"3888.  UNDERGROUND  APARTMENTS.— No  basement,  cellar, 
underground  apartment,  or  other  place  which  the  commissioner  of  labor 
shall  condemn  as  unhealthy  and  unsuitable  shall  be  used  as  a  workshop, 

(95) 


factory  or  place  of  business  in  which  any  person  or  persons  shall  be  em- 
ployed." 

"Section  I.  (G.  S.  3851)  FEMALES  IN  CERTAIN  EMPLOY- 
MENTS—HOURS OF  LABOR— No  female  shall  be  employed  in  any 
mercantile  establishment,  retaurant,  lunch  room  or  eating  house  or  kitch- 
en operated  in  connection  therewith  more  than  ten  hours  in  any  one  day 
or  fifty-eight  hours  in  any  one  week,  or  in  any  mechanical  or  manufactur- 
ing establishment  more  than  nine  hours  in  any  one  day  or  fifty- four 
hours  in  any  one  week,  or  in  any  telephone  or  telegraph  establishment 
more  than  nine  hours  in  any  one  day  or  fifty- four  hours  in  any  one  week 
in  cities  of  the  first  and  second  class. 

Provided  that  a  different  apportionment  of  hours  may  be  made  for 
the  sole  purpose  of  giving  a  shorter  day's  work  for  one  day  of  the  week, 
and  further  provided  that  the  provisions  of  this  act  shall  not  apply  to 
emplo3rment  required  in  the  canning  or  otherwise  preserving  of  perishable 
fruits,  grains  or  vegetables  where  the  period  of  operating  an  establish- 
ment requiring  such  employment  does  not  exceed  six  weeks  in  duration. 
Provided  further,  that  females  may  be  employed  in  retail  mercantile  es- 
tablishments not  more  than  eleven  hours  on  Saturday  each  week,  but  no 
case  to  exceed  a  total  of  more  than  fifty-eight  hours  in  any  one  week. 

Every  employer  shall  post  in  a  conspicuous  place  in  every  room  in 
which  such  persons  are  employed  a  printed  notice  stating  the  number  of 
hours'  work,  and  the  hours  when  the  time  allowed  for  meals  begins  and 
ends. 

The  printed  forms  of  such  notices  shall  be  provided  by  the  commis- 
sioner of  labor. 

The  employment  of  such  person  at  any  time  other  than  as  stated  in 
said  printed  notice  shall  be  deemed  a  violation  of  the  provisions  of  this 
section  unless  it  appears  that  such  employment  was  to  make  up  time  lost 
on  a  previous  day  of  the  same  week  in  consequence  of  the  stopping  of 
machinery  upon  which  he  or  she  was  employed  or  dependent,  but  no  stop- 
ping of  machinery  for  less  than  thirty  consecutive  minutes  shall  justify 
such  overtime  employment,  nor  shall  overtime  employment  be  authorized 
until  a  written  report  of  the  day  and  hour  of  its  occurence  and  duration 
is  sent  to  the  commissioner  of  labor. 

"Sec.  2.  (G.  S.  3852)  ALLOWANCE  FOR  MEALS.— In  each 
such  establishment  at  least  sixty  minutes  shall  be  allowed  for  the  noon 
day  meal  unless  the  commissioner  of  labor  shall  permit  a  shorter  time. 

Where  employes  are  required  or  permitted  to  work  more  than  one 
hour  after  six  o'clock  p.  m.,  they  shall  be  allowed  at  least  twenty  minutes 
to  obtain  lunch  before  beginning  to  work  overtime." 

"Sec.  3.  (G.  S.  3853  ^  NUMBER  IN  ROOM.— No  more  employes 
shall  be  required  or  permitted  to  work  in  a  room  in  any  such  establish- 
ment than  will  allow  to  each  of  such  employes  not  less  than  four  hundred 
cubic  feet  of  air  space,  unless  by  a  written  permit  of  the  commissioner 

(96) 


of  labor  such  amount  of  air  space  for  each  employe  may  be  reduced  to  not 
less  than  two  hundred  fifty  cubic  feet  of  air  space." 

"Sec.  4.  (G.  S.  3854)  VENTILATION.— The  owner,  agent  or 
lessee  of  any  establishment  shall  provide  in  each  work  room  thereof 
proper  and  sufficient  means  of  ventilation;  if  excessive  heat  be  created 
or  if  steam,  gases,  vapors,  dust  or  other  impurities  that  may  be  injurious 
to  health  be  generated  in  the  use  of  such  establishment,  the  rooms  must 
be  ventilated  in  such  manner  to  render  them  harmless,  so  far  as  is  prac- 
ticable and  in  case  of  the  failure  to  so  ventilate,  the  commissioner  of 
labor  shall  order  such  ventilation  to  be  provided. 

Such  owner,  agent  or  lessee  shall  provide  such  ventilation  within 
twenty  days  after  the  service  upon  him  of  such  order  and  in  case  of  fail- 
ure to  comply  therewith  shall  forfeit  to  the  people  of  the  state  ten  dol- 
lars for  each  day  after  the  expiration  of  such  twenty  days,  to  be  recov- 
ered by  the  commissioner  of  labor  in  an  action  brought  for  that  purpose." 

"Sec.  5.  (G.  S.  3855)  SANITATION.— Every  factory  and 
work  shop  in  the  state  where  women  and  children  are  employed  and 
where  dust)*  work  is  carried  on  shall  be  lime  washed  or  painted  at  least 
once  in  every  twelve  months. 

Every  floor  of  any  room  of  any  establishment  herein  named  where 
women  are  employed  shall  be  thoroughly  cleaned  with  soap  and  water 
at  least  once  in  six  months  and  every  dressing  room  and  water  closet  in 
such  establishment  shall  be  thoroughly  cleaned  with  soap  and  water  once 
in  every  week." 

Sec'  6.  (G.  S.  3856)  PENALTY  EOR  VIOLATION.— Every 
employer,  superintendent,  owner  or  other  agent  of  any  establishment 
named  in  section  one  hereof  who  violates  any  of  the  provisions  of  this 
chapter  shall  be  guilty  of  a  misdemeanor." 

CHAPTER  21— G.  L.  1913. 

"Section  1.  (G.  S.  3899)  PHYSICIANS  TO  REPORT  CER- 
TAIN CASES  OF  POISON  TO  COMMISSIONER.— Every  physi- 
cian attending  on  or  called  in  to  visit  a  patient  whom  he  believes  to 
be  suffering  from  poisoning  from  lead,  phosphorous,  arsenic  or  mer- 
cury or  their  compounds  or  from  anthrax,  or  from  compressed  air 
illness,  contracted  as  a  result  of  the  nature  of  the  patient's  employment 
shall  send  to  the  commissioner  of  labor  a  notice  stating  the  name  and  full 
postal  address  and  place  of  employment  of  the  patient  and  the  disease 
from  which  in  the  opinion  of  the  physician,  the  patient  is  suffering,  with 
such  other  specific  information  as  may  be  required  by  the  commissioner 
of  labor  and  which  may  be  ascertained  by  the  physician  in  the  course  of 
his  duties." 

"Sec.  2.  (G.  S.  3900)  FAILURE  A  MISDEMEANOR.— If  any 
physician,  when  required  by  section  1  of  this  act  to  send  a  notice,  fails 
forthwith  to  send  the  same,  he  shall  be  guilty  of  a  misdemeanor  and  up- 
on conviction  shall  be  punished  by  a  fine  not  exceeding  ten  dollars,  or  by 
imprisonment  in  the  country  jail  for  not  exceeding  ten  days." 

(97) 


"Sec.  12.  (G.  S.  3850)  PHYSICIAN'S  CERTIFICATE.— In  case 
any  child  appears  to  be  unable  to  perform  the  labor  at  which  he  or  she 
is  employed,  the  officials  of  the  labor  department  or  truant  officers,  shall 
require  the  employer  of  such  child  to  procure  a  certificate  from  a  reput- 
able practicing  physician  duly  designated  for  such  purpose  by  the  school 
board  affirming  the  physical  fitness  of  the  child  for  such  work,  and  a 
child  as  to  whom  such  certificate  cannot  be  obtained  shall  not  be  em- 
ployed. Any  person  refusing  to  produce  the  certificate  herein  required 
upon  demand,  or  who  shall  employ  a  child  when  a  certificate  has  been 
procured  stating  that  such  child  is  physically  unable  to  work,  shall  be 
guilty  of  a  misdemeanor." 

As  is  obvious  from  the  laws  quoted  above  there  are  no  legal  require- 
ments for  medical  examination  or  service  to  employes.  For  the  purpose 
of  this  survey  inquiries  were  made  in  sixty  stores  and  factories  to  see 
how  much  voluntary  health  work  is  being  done.  In  no  case  was  there 
found  am*  medical  examination,  altho  in  some  cases  a  rather  superficial 
physical  examination  was  given,  usually  by  the  matron.  Some  places  of 
employment  had  a  nurse  or  a  combination  of  matron,  nurse,  and  social 
worker  on  call,  and  a  few  had  doctors  called  when  necessary,  altho  not  on 
duty  all  the  time.  On  the  whole,  the  state  of  affairs  was  about  what 
would  be  expected  where  the  State  laws  make  no  definite  stipulations,  and 
where  the  promotion  of  health  among  industrial  workers  is  left  entirely 
to  the  discretion  of  the  individual  employer. 

Information  regarding  mutual  benefit  associations  from  these  same 
stores  and  factories  was  more  definite,  and  accordingly  the  following 
data  was  compiled : 

Stores  and  Factories  visited  60 

Stores  and  Factories  having  Benefit  Societies. 

Under  100  Employes  5    No  information. 

200  to  500  Employes    3     Pay  sickness  and  death  benefits. 

1    Accident  and  death. 

3    Accident,  sickness  and  death. 

1    No  information. 
More  than  500  employes  1     Pays  sickness  and  death  benefits. 

1     Sickness,  accident  and  death. 

3     No  information. 
No    information    1 

19 

Stores  and  Factories  having  Benefit  Societies,  plus  Workman's  Compen- 
sation (State  Law). 

100  to  200   Employes    1  Pays  sickness  and  death  benefits. 

1  Sickness,  accident  and  death. 

200  to   500  Employes    1  Sickness  and  death. 

1  Accident  and  death. 

2  Sickness,    accident    and    death. 
More  than  500  Employes 1  Sickness. 

1     Sickness  and  accident. 
1     Sickness  and  death. 

9 

■     ^  "  r98) 


Workman's  Compensation  (State  Law). 

Less   than    100   Employes    14  •    - 

100  to  200   Employes    6 

200  to   500   Employes    6 

More  than  500  Employes  2 

No  information  1 

~n^L\  :    . 

No  Information 

200  to  500   Employes 1' 

No  information  regarding 
number    of    employes    2 

3 

Similar  tabulations  were  made  for  the  mutual  benefit  societies  and 
fraternal  organizations  in  the  city,  other  than  those  already  listed  among 
the  stores  and  factories,  and  for  the  trade  unions  in  the  city.  Fifty-seven 
mutual  benefit  societies  and  thirty-three  trade  unions  responded  to  our 
questionnaires,  giving  us  the  following  data : 
INFORMATION"  OBTAINED  FROM  57  ORGANIZATIONS. 

Organizations  having  dues  of  25c  or  less : 

Organizations 
No  information 9 

Sickness  $10  a  month.     No  information  regarding  A.  or  D 2 

Sickness,  Accident  and  Death  3 

1     pays  $20  S.,  $20  A.,  and  $500  D. 

1     pays  $7  S.,  $7  A.,  and  $100  D. 

1     pays  $40  S.,  $40  A.,  and  $50  D. 
Sickness  and  Death.     No  information  regarding  Accident... 2 

1     pays  $5  m.  S.,  and  $250  to  $500  Death. 

1     pays  $20  m.  S.,  and  $25  D. 
Only  Death.     No  information  regarding  S.,  or  A 3 

1     pays  $100  death  benefit. 

1     pays  $500  to  $1000. 

1     pays  $900. 

19 

Organizations  having  dues  of  25c  to  50c  a  month : 

No  information  6 

Sickness,   Accident  and   Death   Benefits 8 

1     pays  $65  month  S.,  Benefit,  $65  Mo.  A.  and  $300  D. 

1     pays  $20  month  S.  Benefit,  $20  Mo.  A.  and  $50  D. 

1     pays  $20  months  S.  Benefit,  $20  Mo.  A.  and  $500-$1000  D. 

1     pays  $20  month  S.  Benefit,  $20  Mo.  A.  and  $60  D'. 

1     pays  $20  month  S.  Benefit,  $20  Mo.  A.  and  $50-$100  D. 

1     pays  $24  month  S.  Benefit,  $24  Mo.  A.  and  $50  D. 
Death-no  information  regarding  sickness  and  Accident  3 

1     pays  $100  to  $300  death  benefit. 

1    pays  $250  to  $2,000  death  benefit. 

1     pays  $50  death  benefit. 
Sickness,   no  information   regarding  A.   and   D 2 

1     pays  $25  month. 

1     pays  $16  month. 
Sickness  and  Death,  no  information  regarding  A 4 

1     pays  $24  month  Sickness  and  $250,  500,  1,000  Death. 

1     pays  $5  month  Sickness  and  $1,000  Death. 

1     pays  $20  month  Sickness  and  $75  Death. 

1     pays  $8  month  Sickness  and  $800  Death. 
Sickness  $20  month,  A.  $20  a  month,  no  information  regarding  D...    1 


(99) 


-24 


Organizations  having  dues  of  50c  to  $1.00  a  month: 

Organizations 
Sickness  and  Death,  no  information  regarding  Accident 3 

1     pars  $20  month  for  S.  and  $600  D. 

1     pays  $20  month  for  S.  and  $50  D. 

1     pays  $20  month  for  S.  and  $1,000  D. 
Sickness,  no  information  regarding  Accident  or  Death 2 

1     pays  $17  month  Sickness. 

1     pays  $10  month  Sickness. 
Sickness  $5,  Accident  $5,  and  Death  $100,  $200,  $300 1 6 

Organizations  having  dues  over  $1.00  a  month: 

Xo   information    3 

1  pays  $75  Death  benefit,  no  information  Sickness 

and  Accident  1 4 

Organizations  having  no  information  regarding  dues  paid  monthly: 

No   information    1 

Death,  no  information  S.  and  A 3  4 4 

Total    57 

Information  obtained  from  33  Unions  in  St.  Paul. 
Unions  having  dues  of  50c  a  month  or  less : 

No   information    2 

Sickness  and  Accident  $20  month,  Death  $40  1 

Sickness  and  Accident  $30  Month.     Xo  information  Death 1 

Death,  but  no  information  regarding  Sickness  and  Accident 4 

2  paying  $100  Death  benefit. 
1     paying  $1.50  death  benefit. 

1  paying  $4,000  Death  benefit. 
Unions  having  dues  of  50c  to  $1.00  a  month : 

No  information  1 

Paying^  Sickness,  Accident  and  Death  Benefits  5 

2  paying  $20  month  S.  and  A.  and  $100  Death. 

1     paying  $20  month  S.  and  A.  and  $50  to  $300  D. 

1     paving  $50  month  S.  and  A.  and  $50  D. 

1     paying  $20  month  S.  and  A    and  $1,000  D. 

Xo  information  S.  and  A.  pays  $100  Death  benefit 1 

No  information  regarding  D.  but  pays  $12  mo.  S.  and  A 1 

]'   ~  T  -       8 

Unions  having  dues  of  $1.00  to  $1.50  a  month: 

Xo  information  , 2 

Sickness,    Accident   and    Death   benefits 5 

1     paying  $20  month  S.  and  $40  D. 

1     paving  $28  month  S.  and  A.  and  $500  D. 

1     paying  $28  month  S.  and  A.  and  $300  D. 

1     paying  $32  month  S.  and  A.  and  $114. 

1     paying  $20  month  S.  and  A.  and  $2,000. 

Xo  information  regarding  S.  and  A.  but  2 

9 

1     paying  $100  Death  benefit. 

1     paying$50  Death  benefit. 

Unions  having  no  information  regarding  dues  paid  monthly: 

No  information 5 

Sickness,  Accident  and  Death  benefits    2 

1     paying  $20  month  S.  and  A.  and  $100  D. 

1     paying  $40  month  S.  and  A.  and  $475  D. 
Xo  information  regarding  S.  and  A.  but  $75  D 1 

Total 33 

(100) 


The  above  tabulations  do  not  lend  themselves  easily  to  interpretation 
because  the  classifications  are  so  numerous  and  so  lacking  in  similarity 
that  they  do  not  allow  reliable  statistical  conclusions.  However,  it  is 
possible  to  state  that  out  of  60  stores  and  factories  there  are  about  one- 
third  which  have  benefit  societies,  about  one-sixth  having  benefit  societies 
and  also  agreeing  to  operate  under  the  State  Workman's  Compensation 
Law,  and  practically  one-half  that  have  no  benefit  organizations  but  agree 
to  the  Workman's  Compensation  Law.  Furthermore,  out  of  the  57  fra- 
ternal organizations  listed  there  are  paid  in  varying  amounts  sick  bene- 
fits by  25  organizations,  accident  benefits  by  1 1  organizations,  and  death 
benefits  by  25  organizations.  In  the  case  of  the  33  unions  listed  14  paid 
sick  benefits,  14  accident  benefits,  and  19  paid  death  benefits,  all  in  vary* 
ing  amounts. 


(101) 


Conclusions 


Each  chapter  in  the  study  contains  certain  statements  regarding  the 
existing  conditions  of  sanitation  and  health  service  in  the  City  of  St. 
Paul  that  pertain  to  the  subjects  under  discussion.  There  are  certain 
general  conclusions,  however,  which  would  be  drawn  from  the  report 
and  which  briefly  stated  are  as  follows : 

1.  The  Health  Bureau  of  the  City  of  St.  Paul  has  been  under  in- 
vestigation two  different  times  during  the  last  five  or  six  years  and 
many  of  the  defects  found  have  not  been  removed  nor  have  the  recom- 
mendations made  been  carried  out. 

2.  The  City  of  St.  Paul  does  not  have  the  lowest  death  rate  of  any 
city  in  the  United  States  if  we  use  the  figures  of  the  United  States 
Census  for  the  basis  of  .our  inquiry. 

3.  The  death  rate  from  preventable  diseases  shows  an  undue  failure 
to  use  preventive  methods  for  the  control  of  such  diseases.  This  is 
especially  true  of  tuberculosis,  measles,  scarlet  fever,  diphtheria,  etc. 

4.  The  enforcement  of  the  Housing  Ordinance  passed  by  the  City 
Council  in  March,  1918,  is  lax.  This  is  due  to  a  shortage  of  inspectors 
and  a  poor  record  system. 

5.  The  water  supply  is  adequate  and  of  good  quality  but  large  num- 
bers of  families  do  not  enjoy  the  advantage  of  using  city  water.  Ap- 
proximately 21.9%  of  the  families  in  the  city  are  not  using  city  water. 

6.  The  removal  of  waste  entails  an  expenditure  of  many  thousands 
of  dollars  to  the  city  and  no  provisions  have  been  made  to  salvage  the 
marketable  products  contained  in  this  waste. 

7.  The  sections  of  the  City  Charter  dealing  with  health  and  sanita- 
tion in  the  City  of  St.  Paul  are  confusing,  afford  opportunities  for  over- 
lapping of  service  and  division  of  responsibility.  It  is  evident  that  a 
complete  revision  of  these  sections  in  the  City  Charter  is  absolutely  es- 
sential before  efficient  health  work  can  be  done  by  the  City  of  St.  Paul. 

8.  The  system  of  records  kept  in  the  Bureau  of  Health  is  inade- 
quate and  many  recommendations  which  have  been  made  by  the  investi- 
gator of  the  Federal  Government  and  by  the  St.  Paul  Association  have 
never  been  carried  out. 

9.  The  food  inspection  and  particularly  the  milk  and  dairy  inspec- 
tion require  a  complete  readjustment  and  a  clearer  division  of  the  re- 
sponsibility between  the  State  and  City  before  adequate  service  will  be 
secured. 

10.  There  are  a  very  large  number  of  private  agencies  carrying  on 
health  work  which  are  rendering  remarkable  service.  There  is,  how- 
ever, some  duplication,  particularly  in  the  field  of  nursing  where  correla- 
tion of  the  services  would  lead  to  economy  and  a  higher  degree  of  effi- 
ciency. 

(102) 


11.  The  sanitary  work  in  the  schools  is  being  carried  on  as  efficient- 
ly as  is  possible  under  the  conditions  afforded  in  the  schools.  It  is  un- 
fortunate, however,  that  approximately  one-fourth  of  the  school  children 
do  not  come  within  the  jurisdiction  of  the  Department  of  Education  be- 
cause they  are  attending  private  and  parochial  schools. 

12.  The  amount  of  contagious  disease  among  school  children  is  such 
as  to  indicate  the  need  for  more  intensive  service  of  both  the  medical  and 
the  nursing  staff. 

13.  The  general  sanitary  conditions  in  the  schools  are  in  many  in- 
stances deplorable  as  was  indicated  in  the  School  Survey  which  was 
made  some  time  prior  to  the  preparation  of  this  report.  A  very -consid- 
erable amount  of  work  should  be  done  in  improving  the  sanitary  condi- 
tions of  the  schools  of  the  City  of  St.  Paul  since  lighting,  toilet  facilities, 
etc.,  require  immediate  attention. 

14.  It  is  remarkable  that  practically  all  of  the  dispensary  work  done 
in  the  City  of  St.  Paul  is  done  under  private  auspices  rather  than  under 
the  direction  and  at  the  expense  of  the  city. 

While  the  conditions  in  general  do  not  give  cause  for  undue  alarm, 
the  naturally  healthful  climate  of  St.  Paul  and  the  general  conditions  of 
sanitation  due  to  the  geographic  location  of  the  community  should  make 
it  possible  to  place  St.  Paul  at  the  head  of  the  list  of  healthful  cities  in 
the  country.  This  can  be  accomplished  by  a  very  slight  increase  of  the 
expenditure  for  health,  by  revision  of  the  present  charter,  and  a  shifting 
and  increase  in  the  present  personnel  employed  by  the  city  government. 


(103) 


PRESS  OF  W.   A.   KELLER  CO.,  ST.    PAUL 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  library  rules  or  by  special  arrangement  with 


tne  .Librarian  i 

n  cnarge. 

DATE   BORROWED 

DATE   DUE 

DATE   BORROWED 

DATE   DUE 

li 

~"-" 

■ 

C2S ( 842)  M5C 

